Asthma

Question 1

MAST Cells

Answer 1

initiate arousal condition in IgE receptors

Question 2

Eosinophils

Answer 2

release granular protein that damages bronchial epithelium and promotes airway hyper-responsiveness.

Question 3

Lymphocytes

Answer 3

produce Cytokenes, Leukotriene B-4 and C-4, prostaglandin and histamine.

Question 4

Leukotrienes: Potent Inflammatory Mediators

Answer 4

Increase vascular permeability /edema
Increase mucus production
Decrease mucociliary transport
Inflammatory cell recruitment i.e. eosinophils—release inflammatory mediators i.e. cationic proteins

Question 5

Intrinsic asthma

Answer 5

Considered non-immune (non-IgE)
Usually no personal or family hx
Serum IgE levels are normal
Usually develops in later life
Ex. EIA, GERD, ASA, inhaled irritants, cold, stress

Question 6

Extrinsic asthma

Answer 6

Initiated by Type-1 Hypersensitivy reaction
Occupational asthma
Allergic bronchopulmonary aspergillosis
Atopic

Question 7

Step 1: Mild intermittent

Answer 7

Daytime asthma symptoms occurring two or fewer days per week
Two or fewer nocturnal awakenings per month
Use of short-acting beta agonists to relieve symptoms fewer than two times a week
FEV1 measurements between exacerbations that are consistently within the normal range (80% of predicted normal)
One or no exacerbations requiring oral glucocorticoids per year

Short acting beta-2- for rescue – PRN - albuterol
(using > 2 times/wk may indicate need to start long-term-control therapy.)

Question 8

Step 2: Mild persistent

Answer 8

Symptoms more than twice weekly (although less than daily)
Three to four nocturnal awakenings per month due to asthma
Use of short-acting beta agonists to relieve symptoms more than two times a week (but not daily)
FEV1 measurements within normal range (80% of predicted normal)
Two or more exacerbations requiring oral glucocorticoids per year.

Short acting beta-2 for rescue – PRN – albuterol
(using > 2 times/wk may indicate need to start long-term-control therapy.)
Low dose inhaled steroids or cromolyn or nedocromil, Leukotriene inhibitors

Question 9

Step 3: Moderate persistent

Answer 9

Daily symptoms of asthma
Nocturnal awakenings more than once per week
Daily need for short-acting beta agonists for symptom relief
FEV1 between 60 and 80 percent of predicted
Two or more exacerbations requiring oral glucocorticoids per year.

Short acting beta-2 for rescue – PRN – albuterol
(using > 2 times/wk may indicate need to start long-term-control therapy.)
Either an inhaled steroid (medium dose) OR inhaled steroid (low-medium dose) AND either long acting inhaled B2 agonist or sustained release theophylline.

Question 10

Step 4: Severe persistent

Answer 10

Symptoms of asthma throughout the day
Nocturnal awakenings nightly
Need for short-acting beta agonists for symptom relief several times per day
FEV1 < 60% of predicted
Two or more exacerbations requiring oral glucocorticoids per year

Short acting beta-2 for rescue – PRN - albuterol
(using > 2 times/wk may indicate need to start long-term-control therapy.)
High dose inhaled steroid AND either a long acting B2 agonist or sustained release theophylline or long acting oral B2 agonist AND oral steroids.

Question 11

Status Asthmaticus

Answer 11

Severe Bronchospasm that is unresponsive to routine therapy.
sudden and rapidly fatal
history of progressive dyspnea with increasing bronchodilator use