28 - Asthma

Question 1

3 features of asthma

Answer 1

Hypertrophy of airway wall muscle
Increased mucous production
Inflammatory cell infiltration

Question 2

What is the prevalence of Asthma in children and adults

Answer 2

20 % prevalence in children

15 % prevalence in adults

Question 3

What cells do allergens activate in an asthmatic

Answer 3

Th2 cells

Question 4

What IL are B cells activated by and what do B cells produce

Answer 4

IL4
IL13

produce IgE

Question 5

What cells does IgE activate

Answer 5

Mast Cells

Question 6

What does mast cells release

Answer 6

Histamine
Prostaglandins
LTC4
Kinins

Question 7

What do the mediators do

Answer 7

activate nerve endings, make mucus, airway wall oedema and bronchodilation

Question 8

What happens to the FEV1/FVC ratio after an asthma attack

Answer 8

Decreases as FEV1 decreases but FVC is the same

Question 9

What is the response to bronchodilators in asthma

Answer 9

Increase in FEV1 - reversibility of obstruction (characteristic of Asthma)

Question 10

What is challenge testing

Answer 10

Use PEFR over time and environment to observe if the history is correct

Question 11

Why can exercise not be good for asthmatics

Answer 11

Increases ventilation

Causes cooling and spasm

Question 12

What can untreated asthma lead to

Answer 12

Bronchitis

COPD

Question 13

What is the treatment for asthma

Answer 13

• 1 – Salbutamol
• 2 – Regular inhaled steroids
• 3 – + Long acting bronchodilators + increase inhaled steroids, consider leukotriene antagonists
• 4 – Theophyllines, leukotriene antagonists, anticholinergics
• 5 – Oral steroids, review diagnosis, consider anti IgE therapy, steroid sparing agents, statins/anti inflammatory agents, thermoplasty, anti-IL5 and anti IL4 receptor treatment

Question 14

How does smoking affect asthmatics

Answer 14

• Causes oxidative stress by increasing NF Kb

* Blocks steroid response by HDAC2 – activated by theophyllines