Asthma, COPD, & TB

Question 1

What are the three possible airway obstructions in asthma?

Answer 1

• Airway hyperresponsiveness
• Mucus hypersecretion
• Plastic bronchitis

Question 2

Which antibody is elevated in the serum of asthmatics?

Answer 2

IgE

Question 3

Which kinds of helper T cells are present in the lungs of asthmatics?

Answer 3

Th2

Th17

Question 4

What interleukin does Th17 produce?

Answer 4

IL-17 (A and F)

Question 5

Which interleukin is the most important differentiation factor for Th2 cells and IgE-secreting B cells?

Answer 5

-IL-4

Question 6

Which interleukin favors the development of eosinophils?

Answer 6

-IL-5

Question 7

Which interleukin is the most important mediator of most features of the asthma phenotype?

Answer 7

-IL-13

Question 8

What is the methacholine challenge test for asthma?

Answer 8

• muscarinic agonist
• triggers smooth muscle contraction
• asthmatics will have greater sensitivity to lower levels of methacholine compared to normal folks

Question 9

What cells drive asthma?

Answer 9

-Th2

Question 10

What is the intrinsic cause of asthma?

Answer 10

Adaptive immune response involving Th2 cells and secreted cytokines, especially IL-13.

Question 11

What activates the extrinsic cause of asthma?

Answer 11

• Exogenous proteases activates Th2 cells, which then secrete IL-4, 5, and 13
• natural sources of proteases from pollen and fungi are linked to asthma

Question 12

What are the two phenotypes of COPD?

Answer 12

• pink puffer

- blue bloater

Question 13

What are the radiological findings of emphysema?

Answer 13

• flattening of the diaphragm
• widening of the retrosternal air space
• Physical loss of lung seen on CT

Question 14

What kind of T cells are found in the lungs of those with emphysema?

Answer 14

• Th 1 & Th17
• no Th2, key difference between COPD and asthma
• Decreased Treg cells

Question 15

What keeps the medium sized airways open?

Answer 15

Elastin cables

Question 16

In patients with COPD, how to T cells respond to elastin?

Answer 16

• produce IFN-gamma and IL-10

* shows emphysema is an Autoimmune issue

Question 17

Can emphysema be caused in IL-17 knockout mice?

Answer 17

No

Question 18

What is Emphysema?

Answer 18

Emphysema is a chronic disease with an anti-elastin, autoimmune component in which the lung structural matrix protein elasin is destroyed by elastases that are induced innately and amplified by adaptiveTh1 and Th17 cell responses

Question 19

What should treatment of COPD be focused on?

Answer 19

• achieving bronchodilation

- Turning off the Th1/Th17 response

Question 20

Compare the Fundamental causes of Asthma Vs. emphysema.

Answer 20

Asthma: Proteinases & Fungi

Emphysema: Smoke

Question 21

Compare the physiological findings of Asthma Vs. emphysema.

Answer 21

Asthma: Reversible airway obstruction

Emphysema: Irreversible airway obstruction

Question 22

Compare the immune profile of Asthma Vs. emphysema.

Answer 22

Asthma: Th2, Th17, IgE. No autimunity

Emphysema: Th1, Th17. Strong Autimmune component

Question 23

1. Physiologically, asthma is characterized by the following (select the best answer):
   A. Fixed airway obstruction
   B. Hyperresponsiveness to methacholine challenge
   C. Th2 and Th17 cell-driven allergic airway inflammation
   D. Chronic hypoxemia
   E. B and C

Answer 23

E. B and C

Question 24

3. True or false (pick the best answer)
   Allergic inflammation in asthma is maladaptive and a major goal of therapy is to suppress it.

A. True
B. False

Answer 24

B. False

Question 25

What happens when TB bacteria is ingested by macrophages?

Answer 25

- they are adapted to live inside macrophage - carried to lymph node by macrophage - replicate and lyse the cell - kinda like a virus

Question 26

When are corticosteroids used to treat pediatric TB?

Answer 26

- when host inflammatory response is contributing to tissue damage or dysfunction - meningitis, endobronchial, miliary w/ alveolar block, pericardial w/ constriction, vertebral w/ spinal root irritation

Question 27

What are the two ways to test for asthma?

Answer 27

- spirometry | - methacholine test

Question 28

Physiologically, emphysema is characterized by which of the following? ``` A. Fixed airway obstruction B. Preserved lung architecture despite marked hypoxemia C. Predominant Th2 cells in the lung D. Loss of lung volume E. Weight gain ```

Answer 28

A. fIxed airway obstruction

Question 29

Potential future therapies for emphysema might include which of the following? ``` A. Beta-2 adrenergic receptor agonists B. Glucocorticosteroids C. Peroxisome proliferator activated receptor gamma (PPAR-g) agonists (e.g., rosiglitazone) D. Insulin E. Smoking cessation intervention ```

Answer 29

C. Peroxisome proliferator activated receptor gamma (PPAR-g) agonists (e.g., rosiglitazone)

Question 30

Which of the following contribute to the pathogenesis of emphysema? ``` A. Th2 cells B. Immunoglobulin E (IgE) and mast cells C. Elastases D. Tree pollens E. Obesity ```

Answer 30

C. Elastases

Question 31

Which TB patients are the most infectious?

Answer 31

- those that are sputum AFB smear positive (see TB under microscope) * children tend not to manifest like this, and thus are not usually infectious

Question 32

Why do children tend to be less infectious when they have active TB?

Answer 32

-don't have the bacteria in their sputum

Question 33

What are things that can cause a decreased ppd response?

Answer 33

- more sick = less likely to have a positive skin test - immunosuppressed states - improper storage and dilution of the tuberculin in the skin test

Question 34

Which interleukin is essential for granuloma formation?

Answer 34

IL-17

Question 35

Why are TNF-a inhibitors contraindicated in TB patients?

Answer 35

- they will block TNF-a, thus preventing granuloma formation | - will result in widespread damage and death

Question 36

What is Miliary TB?

Answer 36

- hematogenous dissemination of a large number of organisms - Negative PPD in 50% - Lack of T--cell proliferation, therefore tends to be aggressive

Question 37

What is the difference in immune response between pulmonary TB and pleural, Lymph node, and latent TB

Answer 37

-pulmonary TB has a higher ratio of Th2 cells to Th1 cells