Asthma

Question 1

Where is the greatest resistance in the lungs?

Answer 1

Medium bronchi

Has contraction from vagus nerves and ciliated cells

Question 2

Describe smokers lungs

Answer 2

They lose cilliated cells that mutate to cells more adaptive to abrasions. This causes mucus to fall into lungs, and why they develop coughs, especially in the morning.

Question 3

______ has cartilage, and ________ does not.

Answer 3

Bronchi

bronchioles

Question 4

What is an obstructive disorder?

Answer 4

hyperactive airways

airway more collapsed
excessive mucous
airway overreacts to vagus nerve stimulation

-Asthma, Chronic bronchitis, emphysema, COPD

Question 5

How do Obstructive disorders present?

Answer 5

Dyspnea
wheezing

Question 6

Asthma is the most common in_____

Answer 6

Children

Question 7

Describe the histamine challenge

Answer 7

In symptom-free adults with asthma, if you spray histamine in the air, you will see a decrease in exhale force

Question 8

What is increasing obstructive diseases?

Answer 8

Infant second hand smoke
Worsening air quality
Hygiene hypothesis

Question 9

What is hygiene hypothesis?

Answer 9

Not exposing children to enough, allergens and germs, therefore causing their immune system to not act normally

Also increasing the amount of auto immune diseases

Question 10

Describe Asthma

Answer 10

S/S: Wheezing, breathlessness, chest tightness, coughing (esp. night/morning), airway inflammation, smooth muscle contraction, mucosal thickening.

-increased WBC, bronchoconstriction, mucosal edema, and mucus hypersecretion. even when airway is relaxed

triggers: allergens, respiratory infections, irritants, certain medications, exercise, gastroesophageal reflux disease, anxiety, and stress

Question 11

How do you Dx Asthma?

Answer 11

1. FEV1: Forced expiratory volume - Inhaled small concentration of histamine and compare exhale over 1 second to prior
2. PEF: Peak expiratory flow - max flow of forced expiration based on sex/age

Question 12

Dead space in lungs ______ with age

Answer 12

increase

Question 13

What is the Tx for Asthma?

Answer 13

Beta-2 specific agonist

Anti-inflammatory as adjuncts

Question 14

What are the 2 types of asthma?

Answer 14

Intrinsic: genetic factors/alleles more inclined to asthma

Atopic (extrinsic): reactions that occur when exposed to certain allergens

Question 15

Describe what happens in an Atopic (extrinsic) reaction

Answer 15

Dendrite cells in the respiratory tract + allergen -> T Helper cell binds to the MHC2-R -> this produces IL4 -> IL4 binds with B cells -> These cells produce plasma cells or antibodies -> IgE which elicits an allergic response then binds to mast cells -> The next time this person is exposed to this allergen the mast cell will degranulate and cause allergic response including: mucus, secretion, capillary, dilation, allergic response, itching, hayfever, anaphylaxis

Question 16

What mediators are responsible in asthma?

Answer 16

Early: Histamines, leukotrienes, prostaglandins = bronchoconstriction & vascular leakage

Late: Leukotrienes, platelet-activating factor, tryptase = sustained bronchoconstriction, cellular infiltration, and mucus hypersecretion

Question 17

When does late response occur in asthma?

Answer 17

2-8 hours

Question 18

What cells produce mucous? and where are they located

Answer 18

Goblet cells

GI and respiratory tract

Question 19

What is mucous made of?

Answer 19

95% water
5% glycoproteins

Question 20

What does mucus do?

Answer 20

Grabs irritants before they go down into the lungs

Question 21

Describe the immune response to allergens as it pertains to the following cells: dendritic cells, T cells, B cells, plasma cells, mast cells, neutrophils, and eosinophils

Answer 21

Dendritic cells: Process and present allergen to T cells

T helper cells: Release IL-4 to activate B cells

B cells: Produce IgE antibodies that bind to mast cells

Plasma cells: Secrete IgE antibodies

Mast cells: Degranulate and release histamine, leukotrienes, prostaglandins

Neutrophils and eosinophils: Release proteases that contribute to inflammation

Question 22

List the primary pathways of the arachidonic acid cascade, and its main products

Answer 22

Lox pathway: Produces leukotrienes

Cox pathway: Produces prostaglandins

Question 23

Describe Coup

Answer 23

Common in 6mon - 5years

Viral RSV

Seal like barking cough

Question 24

How do you treat Croup?

Answer 24

Nebulized Epi
Humidity

Question 25

Identify ANS effects on airwDesay diameter.

Answer 25

Parasympathetic (vagus nerve): Bronchoconstriction through vagal stimulation & Ach Sympathetic: Bronchodilation through beta-2-R and relaxation of smooth muscle

Question 26

Describe the strategies of drug treatment of asthma and COPD and the two broad categories.

Answer 26

Short-term relievers (bronchodilators): Sympathomimetics like beta agonists Long-term controllers (anti-inflammatories, antibodies, leukotriene inhibitors): Corticosteroids and other injectable medications

Question 27

List the major classes of drugs used in asthma and COPD

Answer 27

Short-term relievers: Beta-agonists, methylxanthines, anticholinergics/antimuscarinics Long-term controllers: Corticosteroids, leukotriene inhibitors, antibodies

Question 28

What is COPD?

Answer 28

Chronic bronitis: cough & hypersecretion of mucus for 3 months of the year for 2 years and Emphysema: enlargment of gas exchange airways, destruction of alveolar, loss of elastic recoil -> distended bronchioles and alveolus

Question 29

Describe the mechanisms of action of these drug groups Beta-agonists, methylxanthines, anticholinergics/antimuscarinics, Corticosteroids, leukotriene inhibitors, antibodies

Answer 29

Beta-agonists: Relax airway smooth muscle and inhibit substances from mast cells Methylxanthines: Inhibit phosphodiesterase, increase cAMP Anticholinergics/Antimuscarinics: Block muscarinic receptors, inhibit bronchoconstriction Anti-inflammatories (corticosteroids): Reduce inflammation by suppressing the immune response Leukotriene inhibitors: Block leukotriene synthesis or receptors Antibodies: Block cytokines/mediators (e.g. dupilumab blocks IL-4)

Question 30

Identify treatment considerations for specific patients with mild, moderate, or severe asthma and/or COPD.

Answer 30

Mild asthma: Short-term relievers as needed (i.e. rescue inhalers) Moderate-severe asthma: Short-term relievers plus long-term controllers -> inhaled corticosteroids & PO leukotriene pathway inhibitor COPD: Combination of bronchodilators and anti-inflammatories -> PO/inhaled corticosteroids, anti-IgE antibody

Question 31

List Beta-2 Specific Agonist

Answer 31

Albuterol: 30 mins - 4 hrs Lipid soluble & up to 12 hr effects (LABA): Salmeterol Formotorol

Question 32

List Beta Agonist

Answer 32

Epinephrine - SQ or inhaled; max dilation in 15mins Isoproterenol: not used much -> fatal arrhythmias

Question 33

How much of an inhaled dose actually gets into the airway? what is most important when taking an inhaler?

Answer 33

10-20% of dose gets to patient training the patient to use an inhaler

Question 34

List Methylxanthines

Answer 34

**Theophylline (tea or purified)** Theobromine (chocolate) Caffeine (coffee)

Question 35

List Antimuscarinics

Answer 35

Atrovent/Atropine Inhaled ipratropium bromide (longer acting than atrovent)

Question 36

Describe purified Theophylline

Answer 36

narrow therapeutic index (5-20mg/L) used for COPD

Question 37

What route for steroids do you want to use and why?

Answer 37

Inhaled targets lungs directly

Question 38

List Corticosteroids

Answer 38

Prednisone Fluticasone (IM, aerosol) **Blocks transcription/translation**

Question 39

What are adverse effects of corticosteroids?

Answer 39

Suppress immune system Osteoporosis Decrease growth in children Oral yeast infection

Question 40

List Leukotriene pathway inhibitors

Answer 40

Montelukast **Improve aspirin induced asthma** **Use as adjunct** Inhibits 5-lipoxygenase & receptor binding

Question 41

List Monoclonal antibodies to IgE

Answer 41

Omalizumab **Prophylaxis** Once a month - does not activate the IgE on mast cells

Question 42

What does a Nebulizer do?

Answer 42

Make particles small to get through to where they need to be