respiratory > asthma > Flashcards

asthma Flashcards

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1
Q

symptoms

A
  • wheeze
  • chest tightness
  • cough
  • shortness of breath (worse at night)
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2
Q

when does it occur

A

between 3-5 years old

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3
Q

what are the 3 characteristics

A
  • airflow limitation
  • airway hyper-responsiveness
  • bronchial inflammation
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4
Q

is airflow limitation reversible

A

yes

may need treatment to do so

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5
Q

what is present in bronchial inflammation

A
  • T lymphocytes
  • mast cells
  • eosinophils m
  • oedema
  • smooth muscle hypertrophy
  • mucus plugging
  • epithelial damage
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6
Q

what is the skin prick test result

A

positive to common inhalant allergens such as dust mite, animal danders, pollens and fungi

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7
Q

what is childhood asthma often accompanied by

A

eczema

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8
Q

what can be a cause of late onset asthma

A

sensitisation to chemicals or biological products in the workplace

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9
Q

what can cause non-atopic asthma in middle age

A
  • sensitisation to occupation agents
  • intolerance to NSAIDs (aspirin)
  • prescription of beta-adrenoreceptor blockers
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10
Q

causes

A
  • grass pollen
  • domestic pets
  • rhinovirus
  • cold air
  • emotion
  • perfume
  • cigarette smoke
  • NSAIDs
  • Beta blockers
  • genetics
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11
Q

what does term atopy include

A

asthma and hayfever

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12
Q

atopic diseases are those that

A
  • run in families
  • skin reactions to common allergens
  • circulating allergen-specific antibodies (IgE)
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13
Q

what is elevated serum IgE linked to in asthma

A

airway hyper-responsiveness

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14
Q

what genes control cytokine production

A
  • IL-3
  • IL-4
  • IL-5
  • IL-9
  • IL-13

these affect mast cell development and eosinophils

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15
Q

what helper cells are involved in asthma

A

type 2 helper cells

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16
Q

how can airway hyper-responsiveness be demonstrated

A

ask patient to inhale gradually increasing concentrations of histamine or methacholine

aka bronchial provocation test

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17
Q

what would the bronchial provocation test be in asthmatic patient

A

they would respond to a very low dose of methacholine

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18
Q

what other conditions would react to methacholine

A
  • wheezing with viral infection
  • seasonal wheeze
  • allergic rhinitis
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19
Q

what increases the risk of developing some forms of occupational asthma

A

smoking

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20
Q

when do asthmatics usually wheeze

A

after prolonged exercise or inhalation of cold, dry air (air conditioning included)

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21
Q

what is exercise induced wheeze driven by

A

release of histamine, prostaglandins and leukotrienes from mast cells

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22
Q

what can asthmatics experience worsening of symptoms

A
  • exposure to tobacco smoke
  • car exhaust fumes
  • solvents
  • strong perfumes
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23
Q

what drugs implicate asthma

A

NSAIDs

particularly aspirin

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24
Q

what do NSAIDs inhibit

A

arachidonic acid metabolism via the cyclo-oxygenase (COX) pathway

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25
what is there a reduction of in aspirin intolerant asthma
reduce production of PGE2 leads to overproduction of cysteinyl leukotrienes by eosinophils, mast cells and macrophages
26
COX-2 inhibitors trigger asthma attacks true or false
false only COX-1 do
27
what drug contraindicates asthma and should never be given to patient
beta blocker
28
what is the inflammatory component of asthma driven by
Th2 T lymphocytes
29
what response occurs when there is a decrease in sensitivity to corticosteroids
Th1 response with release of mediators such as TNF-alpha
30
where is there an increase in mast cells in asthma
- epithelium - smooth muscle - mucous glands
31
what do mast cells release in asthma
- histamine - tryptase - PGD2 - cysteinyl leukotrienes cause immediate asthmatic reaction
32
where are eosinophils found in asthma
in bronchial wall and secretions
33
how are eosinophils attracted to the airways
by cytokines: - IL-3 - IL-5 - GM-CSF
34
what do eosinophils release when activated
LTC4
35
what drug can decrease activation of eosinophils
corticosteroids
36
epithelium changes
- loss of ciliated columnar cells
37
what is epithelium a major source of
- mediators - cytokines - growth factors these enhance inflammation and promote tissue remodelling
38
what is a useful test for continuing inflammation
measurement of exhaled NO
39
what is smooth muscle like
hyperplasia
40
what happens to the smooth muscle
- contracts more easily | - remains contracted
41
what do smooth muscle secretes
- cytokines - chemokines - growth factors
42
what does acetycholine stimulate
M3
43
symptoms
- wheezing - SOB (episodic) - worse during night - cough
44
what can be done for diagnosis
- PEFR - spirometry - exercise test - CXR - skin prick
45
how is PEFR done
- measure on walking before bronchodilator use | - measure in bed after bronchodilator m
46
what does PEFR show
the diurnal variability
47
how does spirometry show ashtma
greater than 15% improvement in FEV1 following bronchodilator use
48
what is used for diagnosis in children
exercise test
49
how is exercise test done
run for 6 minutes on treadmill
50
what can be seen on CXR
- overinflation
51
treatment for occasional symptoms not everyday
SABA
52
treatment for daily symptoms
corticosteroid
53
treatment for severe symptoms
corticosteroid + LABA if not controlled add either leukotriene or theophylline
54
treatment for severe symptoms that are uncontrolled on high dose corticosteroid
increase corticosteroid + LABA | + leukotriene/theophylline
55
treatment for severe symptoms with patient deteriorating
corticosteroid + prednisolone
56
treatment for severe symptoms and continued deterioration on prednisolone
hospital admission
57
example of SABA
salbutamol
58
example of LABA
salmeterol
59
example of corticosteroid
beclometasone budesonide fluticasone
60
example of leukotriene
monelukast | zafirlukast
61
when can drugs be reassessed
2-3 months after under control
62
what do beta adrenoreceptor agonist do
affect B2 only | - relax the bronchial smooth muscle
63
can LABAs be given on their own
no
64
what are LABAs given with
corticosteroids
65
what does sodium cromoglicate prevent
activation of many inflammatory cells, particularly mast cells, eosinophils and epithelial cells
66
SE of inhaled corticosteroids
- oral candidiasis - hoarseness - osteoporosis
67
drug against IgE
omalizumab
68
features of life threatening attack
- silent chest - exhaustion - bradycardia
69
drugs used for acute severe asthma
- SABA - antimuscarinic - magnesium sulphate - hydrocortisone - predisolone - ventilation
70
order of treatment for acute severe asthma
1. oxygen 2. salbutamol 3. ipatropium 4. hydrocortisone 5. prednisolone 6. magensium sulphate IV
respiratory
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