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Respiratory System > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Chronic inflammation of airways which causes narrowing

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2
Q

Describe how asthma attacks happen and what process take place in the body

A
  • triggered by something in th environment
  • picked up by dendritic cells
  • present to type 2 helper cells - CD4+
  • cytokines releases (IL-4+IL5)
  • IL-4: production of IgE antibodies > coat mast cells and stimulate the release of histamines, leukotrienes + prostaglandins
  • IL-5: act on eosinophils > release more cytokines + leukotrienes
  • causes smooth muscle spasm + increased mucous secretion
  • also increased vascular permeability > immune cells from blood > eosinophils damage endothelium of lung
  • airways become even narrower
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3
Q

What immune cells are in involved asthma?

A

Type 2 helper cells
B cells > plasma cells > antibodies

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4
Q

What is the atopic triad?

A

Asthma
Atopic dermatitis
Allergic rhinitis

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5
Q

What type of reaction do IgE antibodies cause?

A

Type 1 hypersensitivity

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6
Q

What cytokines are released in asthma?

A

IL-4
IL-5

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7
Q

What does the release of IL-4 cause?

A
  • production of IgE antibodies (type 1 hypersensitivity reaction)
  • IgE coat mast cells
  • histamines, leukotrienes + prostaglandins are released
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8
Q

What does the release of IL-5 cause?

A
  • act on eosinophils
  • release leukotrienes + more cytokines
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9
Q

Is asthma restrictive or obstructive?

A

Obstructive

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10
Q

What does chronic asthma cause?

A

Airways remodelling - irreversible changes
- hypertrophy + hyperplasia of smooth muscle
- hypertrophy of mucous glands
- thickening of basement membrane

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11
Q

Causes of asthma

A

Genetic factors (family history)
Environmental factors

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12
Q

Triggering substance of asthma

A
  • air pollution: cigarette smoke, car fumes
  • allergens: dust, animals, mould, pollen
  • medication: aspirin (NSAIDs), beta blockers
  • cold air
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13
Q

Symptoms of asthma

A
  • dry cough (often at night)
  • chest tightness
  • dyspnoea
  • wheezing/high pitched whistling on exhalation on
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14
Q

What three processes affect the airways in an asthma attack?

A
  • smooth muscle spasm
  • increased mucous secretion
  • increased vascular permeability > immune cells from blood > eosinophils damage endothelium of lung

Makes airways even narrower

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15
Q

What is asthma characterised by?

A

A triad of:
- bronchial smooth muscle contraction
- airways inflammation
- increased secretions

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16
Q

Management of asthma

A
  • education
  • up to date vaccinations
  • avoid triggers
  • drug treatment: bronchodilators + steroids
  • inhalers
17
Q

What are the two phases of immune response in asthma?

A

Immediate response: type 1 hypersensitivity (IgE) > bronchial smooth muscle contraction
Late phase response: type IV hypersensitivity (eosinophils) > airways inflammation

18
Q

Outline the immediate response to asthma triggers

A
  • type 1 hypersensitivity
  • production of IgE antibodies
  • coat mast cells
  • histamine, prostaglandins + leukotrienes released
  • causes bronchoconstriciton
19
Q

Outline the late phase response in asthma triggers

A
  • type IV hypersensitivity
  • includes inflammatory cells e.g. eosinophils, mast cells, lymphocytes, neutrophils
  • release leukotrienes + cytokines
  • causes airway inflammation
20
Q

What features of airway inflammation cause reduced airflow?

A
  • mucosal swelling (oedema)
  • thickening of bronchial walls
  • mucous over production
  • smooth muscle contraction
  • epithelium is shed + incorporated into thick mucous
    .
  • triggers airway hyper-responsiveness
21
Q

What are the effects of airway narrowing on gas exchange?

A

reduced ventilation > V/Q mismatch

22
Q

How can asthma cause type 1 respiratory failure?

A
  • in unmanaged mild asthma
  • airways narrowing > reduced ventilation
  • hyperventilation can’t compensate for hypoxaemia but can compensate for CO2 retention
  • low pCO2 + low pO2
23
Q

What is a sign of life threatening asthma?

A

Increasing pCO2

24
Q

How can asthma cause type 2 respiratory failure?

A
  • in severe attacks
  • complete blockage of some airways + exhaustion which limits amount of CO2 which can be breathed out
  • this leads to a rise in CO2 in body
  • high pCO2 + low PO2
25
Q

Why might a normal pCO2 level on ABG be concerning in a patient having a acute asthma exacerbation?

A
  • initially the patient is hypocapnic
  • the asthma attack continues + severity of airflow obstruction increases
  • the hypocapnia becomes normocapnia before becoming hyercapnia
  • normocapnia is a step in the progression from type 1 respiratory failure to type 2
26
Q

Describe airway hyperresponsiveness

A
  • inflammation makes airway more ‘reactive’ to triggers
  • triggers can cause bronchoconstriction
27
Q

What type of countries is asthma more prevalent in?

A

High income countries

28
Q

Describe an asthmatic’s airway when they are well/symptom free

A

Inflamed + thickened walls

29
Q

Describe an asthmatic’s airway during an attack

A
  • inflamed + thickened wall
  • increased mucous
  • tightening smooth muscle
  • air trapped in alveoli
30
Q

What is atropy?

A

Genetic tendency to develop allergic diseases

31
Q

What type of pattern is seen in spirometry of a person with asthma?

A

Obstructive

32
Q

Why is a dry cough in asthma more common at night?

A

Increased vagal activity at night

33
Q

Stepwise approach of medications in asthma

A

Only move onto next step if current step isn’t working:
- short acting B2 agonist e.g. salbutamol, terbutaline
- inhaled corticosteroid e.g. beclomethasone
- long acting B2 agonist e..g salmeterol, formoterol
- higher dose ICS, leukotriene receptor antagonists
- referral to specialist care

34
Q

What is rhinitis?

A

Inflammation of mucous membrane inside nose

35
Q

Blue vs brown inhalers

A

Blue: bronchodilator acts a reliever (short term)
Brown: anti inflammatory (corticosteroids) to reduce risks of asthma attacks (longer term)

36
Q

How do you manage asthma exacerbations?

A
  • oxygen
  • bronchodilators e.g. salbutamol
  • steroids
  • +/- antibiotics
37
Q

What investigations can be used to diagnose asthma?

A

Peak flow
Spirometry

Respiratory System (20 decks)

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