Asthma

Question 1

Name 5 chemokines involved in Th2 inflammation. (IgE isn’t a chemokine)

Answer 1

• IL-3
• IL-4
• IL-13
• IL-25
• TSLP

Question 2

What does IL-5 do in the Th2 inflammation pathway?

Answer 2

Differentiation & maturation of eosinophils

Question 3

What does IL-13 do in the Th2 inflammation pathway?

Answer 3

recruitment of eosinophils into airway

Question 4

What does IL-4 do in the Th2 inflammation pathway?

Answer 4

production of IgE by B-Cells (i.e., class switching)

Question 5

What does IgE do in the Th2 inflammation pathway?

Answer 5

activates mast cells & basophils to produce leukotrines and recruit / activate eosinophils.

Question 6

What two commonly used asthma medication classes lower FeNO? Which one does not have an affect?

Answer 6

• ICS and Anti-IL-13 lower it.

- Anti-IL-5 has no effect.

Question 7

What is the difference between exercise-induced asthma and exercise-induced bronchospasm?

Answer 7

• EIA patients only have symptoms when exercising.

- Exercise-induced bronchospasm is something that happens to patients with baseline asthma.

Question 8

Diagnostic test for aspirin-exacerbated respiratory disease (AERD)?

Answer 8

Urine leukotrines after placebo/aspirin adminstration.

Question 9

What disease is this?

• Nasal polyps
• Difficult to control asthma (OCS-dependent)
• Negative FHx and skin allergy testing
• 40s-50s female
• Angio-edema and GI symptoms

Answer 9

AERD (Aspirin-Exacerbated Respiratory Disease)

Question 10

What four questions assess asthma control over the last 4 weeks?
(GINA 2020)

Answer 10

1. Daytime symptoms more than 2/week?
2. Any night awakenings due to asthma?
3. SABA reliever needed more than 2/week?
4. Any activity limitation due to asthma?

Well controlled = none
Partly controlled = 1-2 of these
Poorly controlled = 3+ of these

Question 11

What is asthma step 1 treatment?

Answer 11

As-needed low-dose ICS / Formoterol

Question 12

What is asthma step 2 treatment?

Answer 12

Daily low-dose ICS

-Alternative: daily LTRA

Question 13

What is asthma step 3 treatment?

Answer 13

Daily low-dose ICS / LABA

• Alternative: medium dose ICS
• Alternative: Low-dose ICS + LTRA

Question 14

What is asthma step 4 treatment?

Answer 14

Daily medium dose ICS / LABA
Add on tiotroprium or LTRA
-Alternative: High-dose ICS

Question 15

What is asthma step 5 treatment?

Answer 15

Daily high dose ICS / LABA
Add on tiotroprium or biologic
-Alternative: add on low-dose OCS

Question 16

Target range for theophylline?

Answer 16

8-12

Question 17

In what organ is theophylline metabolized?

Answer 17

Liver

Question 18

What is the ATS / ERS definition of severe asthma?

Answer 18

• High-dose ICS + another agent
• or-
• Needs prednisone >50% of last year.

Question 19

What asthma biologic blocks IgE?

Answer 19

Omalizumab (Xolair)

Question 20

What two asthma biologics blocks IL-5?

Answer 20

Mepolizumab (Nucala)

Reslizumab (Cinquair)

Question 21

What asthma biologic blocks IL-5R?

Answer 21

Benralizumab (Fasenra)

Question 22

What asthma biologic blocks IL-4R?

Answer 22

Dupalimumab (Dupixent)

Question 23

What asthma biologic blocks TSLP?

Answer 23

Tezepelumab (no trade name yet, not yet approved)

Question 24

What is the primary outcome of bronchial thermoplasty?

Answer 24

Decrease smooth muscle thickness and exacerbations.

Question 25

For Th2-low asthma patients, what specific therapy may help?

Answer 25

Azithromycin decreases exacerbations (AMAZES trial)