Asthma Flashcards Preview

Pulmonary > Asthma > Flashcards

Flashcards in Asthma Deck (34):
1

cells involved in asthma

mast cells

eosinophils

T lymphocytes

neutrophils

epithelial cells

2

symptoms of asthma

variable and reversible airflow obstruction

airway wall inflammation

airway hyperreactivity

recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly in early mroning hours

colds "go to the chest" or take more than 10 days to clear

3

current asthma prevalcence is higher among ___

children than adults

boys than girls

women than men

mortality higher among African Americans than Caucasions

4

risk factors for asthma

bronchial hyperresponsiveness

genetic predisposition

gender

early infections

atopy

exposure to indoor allergens

outdoor pollution

exposure to tobacco smoke

obesity

prematurity

diet

inactivity

5

characteristics of the inflammatory response in asthma

cellular infiltration

epithelial disruption

mucosal edema

mucus plugging

6

atopy

the body's redisposition to develop and antibody called immunoglobulin E (IgE) in response to exposure to environmental allergens

can be measured in the blood

includes allergic rhinitis, asthma, hay fever, and eczema

7

status asthmaticus

severe,  life-threatening asthma attacks

8

factors that favor the Th2 phenotype

widespread use of antibiotics

Western lifestyle

urban environment

diet

sensitization to house-dust mites and cockroaches

9

factors favoring the Th1 phenotype

presence of older siblings

early exposure to day care

tuberculosis, measles, or hepatitis A infection

rural environment

10

Th2 interleukins

IL-13, IL-4, and IL-5

11

Discuss the pathophysiology of asthma.

epithelial cell disruption

thickening of the basement membrane (type III and IV collagen)

smooth muscle hypertrophy and hyperplasia

increased number of goblet cells

enlarged submucous glands, intraluminal mucus

infiltration of the bronchial mucosa and sbumucosa by eosinophils, Th2 lymphocytes, mast cells, and othe rinflammatory cells

production of cytokines, arachidonic acid metabolites, bradykinins, and other factors

transcription factors for cytokines elevated as well as NF-kB, promoting production of IgE by plasma cells against specific antigens

mast cells react to antigen and release granules including histamine as well as IL-4 and Il-5, which continues the cycle

12

occupational exposures that can trigger asthma

toluene diisocyanate, flour, wood

13

airway changes in asthma

epithelial cell disruption

thickening of the subendothelial basement membrane

inflammatory infiltrate throughout the lung

enlarged goblet cells and increased number

hypertrophy of smooth muscle

14

stages of inflammation and remodeling in asthma

acute response

chronic inflammation

airway remodeling

15

acute response in asthma

bronchoconstriction

edema

secretions

cough

16

chronic inflammation in asthma

cell recruitment

epithelial damage

early structural changes

17

airway remodeling in asthma

cellular proliferation - smooth muscle, mucous

increased matrix protein deposition

basement membrane thickening

angiogenesis

18

Describe the volume-time curves of spirometry in an asthmatic.

19

Describe the flow-volume loop of spirometry in an asthmatic.

lower peak expiratory flow rate

Scooped, concave exipiration

Increased static volume, decreased forced volume

20

What is a hallmark of asthma in terms of lung function?

displays variability

21

physiology in asthma

expiratory airflow obstruction

inspiratory obstruction minimized by the inverse relationship between lung volume and airway resistance

FEV1 falls mroe than FVC to lower FEV1/FVC

diffusion capacity is normal or slightly increased (angiogenesis -> more blood)

airway hyperreactivity as demonstrated by methacoline provocation - drop more than 20% at low doses

22

therapeutic approach to asthma

education

environmental control measures

peak expiratory flow monitoring

medications

23

criteria for intermittent asthma

symptoms < 2 days a week

nighttime awakenings < 2 times a month

short-acting beta2-agonist use < 2 days a week

no interference with noromal activity

normal FEV1 between exacerbations

FEV1 > 80% predicted

FEV1/FVC normal

0-1 exacerbations per year requiring oral systemic corticosteroids

***not fulfilling any one of these criteria makes it a persistent asthma

24

goals of asthma management

achieve and maintain control of symptoms

maintain normal activity levels, including exercise

maintain pulmonary function as close to normal levels as posssible

prevent asthma exacerbations

avoid adverse effects from asthma medications

prevent asthma mortality

25

medications used to control asthma

inhaled glucocorticosteroids

luekotriene modifiers

long-acting inhaled beta2-agonists with glucocorticosteroids

systemic glucocorticosteroids

theophylline

cormolyn sodium

anti-IgE Ab

26

asthma rescue medications

rapid acting inhaled beta2-agonists

inhaled anticholinergics

theophylline

short-acting oral beta2-agonists

27

What agents have sufficient evidence of a causal relationship with asthma?

cat

cockroach

house dust mite

environmental tobacco smoke (among pre-school aged children)

28

inhaled glucocorticosteorids

budesonide

fluticasone

mometasone

beclomethasone

29

leukotriene modifiers

montelukast

zafirlkast

zileuton

30

long-acting inhaled beta2-agonists + inhaled glucocorticosteroids

salmeterol + fluticasone

formoterol + budesonide

formoterol + mometasone

31

systemic glucocorticosteroids

prednisone

methylprednisolone

32

omalizumab

anti-IgE antibody

33

rapid-acting inhaled beta2-agonists

albuterol

salbutamol

34

inhaled anticholintergics

ipratropium