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1

bronchial asthma

narrowing of peripheral airways in the lung
predominantly inflammatory
primarily reversible
FEV1 and PEFR used to measure

2

copd

chronic obstructive pulmonary disease ]narrowing of peripheral airways in the lung
caused by smoking and exposure to environmental pollutants
predominantly inflalmmatory
combindation of bronchitis and emphysema

3

bronchitis

persisitent cough with mucus production

4

emphysema

destruction of tissues around alveoli

5

status asthmaticus

severe acute asthma that is not readily reversed

6

anatomy of airways

trachea primary bronchi have rings of cartilage
secondary and tertiary bronchi have plates of cartilage
bronchioles don't have cartilage, have smooth muscle which determines the diameter of the bronchiole and thus the flow of air to the alveoli

7

asthmatic airway

smooth muscle hypertrophy
epithelial desquamation
thickening of basement membrane
infiltration of the submucosa by eosinophils and neutrophils
goblet cell metaplasia

8

asthma attacks are biphasic

first phase is bronchospasm and the second phase is nflammatory

9

allergic astma, inflammation of the lung

iteraction of antigen presenting cell with t helper cell activates it to release cytokines such as interleukins
interleukins activate eosinophils and mast cells and also trigger b lymphocytes to differentiate into plasma cells that release IgE antibodies which attach to the mast cells and eosinophils

10

mast cell

when IgE antibodies on surface of mast cells become cross linked with antigen causes hem to degranulate and release preformearly mediatorsed protein meditors

11

early mediators

histamines proteases proteoglycans and chemotactic factors

12

later mediators

derived from embrane lipids
leukptrienes B4, prostaglandins D2, thromboxanes and prostacyclins

13

what causes bronchospasm

leukotrient b4 and prostagland d2 cause contraction of the bronchiall smooth muscle

14

what is epithelial desquamation cause dby

allergen binding to ige on mast cell which causes them to release toxic major basic protein thst damages the respiratory endothelium

15

histamines

early mediaotrs
causes contrction of airway smooth muscle, increased vascular permeavilty and increased bronchial secretions

16

chemotactic factor

early mediators
cause infiltration of lung tissue by neutrophils and eosinophils

17

leaukotriens c4 d4 e4 and prostaglandin d2

later mediators
cause contraction of airways smooth muscle, increased vascular permeability and increased nronchial secretions
the major basic protein comes from eosinophils

18

asthma relievers or bronchodilators

beta 2 adrenoceptor agonists
leukotriene antagonists
theophylline
mAChR antagonists

19

preventers of asthma

long acting beta 2 agonsits
glucocorticosteroids
monoclonal antibodies
leukotriene antagonists

20

non selective b adrenoceptor potency

isoprenaline, adrenaline and then noradrenaline

21

selective beta agonisys

beta 1 dolbutamine
beta 2 is salbutamol

22

dhort acting bronchodilators

salbutamol and terbutaline

23

long acting bronchodilators

salmeterol
has relative lipophilicity allows It to remain in the tissues for longer
can anchornitself to the recetpro

24

how do beta 2 adrenoceptor agonists cause relaxation

gs protein and adenylyl cyclase, leads to active protein kinase a and phosphorylated protein that reduces intracellular calcium conc and leads to relaxation

25

unwanted effects of b agonist bronchodilators

tremor
tachycardia
nervous tension
hypokalaemia

26

ways to administer bronchodilators

metered dose inhaler
spacer
nebuliser