8. Asthma Flashcards Preview

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Flashcards in 8. Asthma Deck (31):
1

what is the end result of all types of asthma?

cellular inf of the airway, enhanced bronchial responsiveness, airflow obstruction.

2

what is atopy?

tendency to form IgE antibody to inhaled allergens (like pollen, dander, dust mites)

3

on gross appearance, what do asthmatic airways look like?

narrower, reddened, edmatous

4

what cell types has the airway been invaded by in asthma?

eosinophils, Th2 cells.

5

what do these invading cells do?

cause local tissue damage, release cytokines which cause the inflammation

6

what is the airflow appearance of an asthmatic?

limited airflow, reduced FEV1, reduced ratio, low PEF. all this caused by inflammation of the airway.

7

what is the primary reason for airflow restriction?

bronchoconstriction. resulting from airway hyperresponsiveness (AHR)

8

things that will trigger asthma?

-allergens
-viral infections
-exercise
-physical factors: cold, dry, humid air, fumes
-occulational factors/allervens

9

clinical presentation of asthma?

wheezing, dyspnea, cough. may be worse at night.

10

physical findings of asthma?

expiratory wheezes, hyperinflation, accessory muscle use, air hunger

11

how will an asthmatic look on spirometry?

normal inspiratory loop. on expiration there may be a decr FEV1 and low ratio. but spirometry may look normal, so can't rule out asthma. after a SABA there may be an improvement in FEV1 which supports an asthma dx.

12

what is the methacholine inhalation challenge?

successive concentrations of methacholine are delivered, and spirometry is done after each dose. causes bronchoconstriction in pts with AHR. the smaller the dose of methacholine that yields a drop in FEV1, the more severe the AHR.

13

comorbidities with asthma?

-rhinosinusitis. causes more difficult asthma control
-GERD. reflex bronchospasm w acid reflux?
-obesitity, obstructive sleep apnea
-triggers/allergens

14

how the measuring the exhaled Nitric Oxide help with asthma diagnosis?

biomarker that reflects lower airway inflammation, correlates with degree of eosinophil inflammation

15

what are the 2 divisions of pharm therapy for asthma?

rescuer, controller

16

rescue medications: 3 types

-Short acting B2 agonists
-anticholinergics
-oral corticosteroids

17

how do short acting B2 agonists (SABAs) work?

most common: inhaled albuterol. activate B2 adrenergic receptor, which is expressed in airway. results in increased intracellular cAMP and smooth muscle relaxation. side effects: tremor, palpitations

18

how do anticholinergics work?

much less effective than SABAs. prevent cholinergic nerve bronchoconstriction. most common is ipratropium. adjunct therapy. side effects: dry mouth.

19

how do oral corticosteroids work?

given in 5-10 day bursts to reverse an asthma flare-up, possibly from a resp infection. extensive side effects (osteopenia, wt gain, HTN) so not used as a typical controller med.

20

controller meds: 5 types

-inhaled corticosteroids
-long acting beta agonists
-antileukotrienes
-anti-IgE
-allergen immunotherapy (allergy shots)

21

how do inhaled corticosteroids work?

most effective controller medication. most common = fluticasone. reduce the number of eosinophils in airway, reduce number of activated t cells and activated mast cells.

22

how do long-acting beta agonists work?

most common: salmeterol. same as SABAs. always used in conjunction with another controller

23

how do antileukotrienes work?

common: montelukast. leukotrienes are produced by mast cells and eosinophils and cause bronchoconstriction. anti-leuks block the LT1 receptor. (Activation of this receptor by LTD4 results in contraction and proliferation of smooth muscle, edema, eosinophil migration and damage to the mucus layer in the lung)

24

how do anti-IgEs work

omalizumab. administered sub-Q every 2-4 weeks. removes the allergen triggered component of asthma.

25

how do allergy shots work?

sim to omalizumab (anti-IgE). can remove IgE effects.

26

controller meds: 5 types

-inhaled corticosteroids
-long acting beta agonists
-antileukotrienes
-anti-IgE
-allergen immunotherapy (allergy shots)

27

how do inhaled corticosteroids work?

most effective controller medication. most common = fluticasone. reduce the number of eosinophils in airway, reduce number of activated t cells and activated mast cells.

28

how do long-acting beta agonists work?

most common: salmeterol. same as SABAs. always used in conjunction with another controller

29

how do antileukotrienes work?

common: montelukast. leukotrienes are produced by mast cells and eosinophils and cause bronchoconstriction. anti-leuks block the LT1 receptor. (Activation of this receptor by LTD4 results in contraction and proliferation of smooth muscle, edema, eosinophil migration and damage to the mucus layer in the lung)

30

how do anti-IgEs work

omalizumab. administered sub-Q every 2-4 weeks. removes the allergen triggered component of asthma.

31

how do allergy shots work?

sim to omalizumab (anti-IgE). can remove IgE effects.