Flashcards in Asthma Deck (60):
Is asthma acute or chronic?
What cells are involved in asthma?
What symptoms are associated with asthma?
When are symptoms more common/worse?
at night or in early morning
Who does asthma affect the most?
If we control asthma, we prevent _____ ?
What does natural history of a disease mean?
It means we let the disease run it's course and do not intervene in any way.
What are predictors of adult asthma persistence?
-diagnosis during school age
-presence of atopy (genetic tendency to develop allergic diseases)
-BHR (bronchial hyper reactivity)
What are 2 non-modifiable risk factors associated with asthma?
-genetics (atopy or BHR)
-gender (more common for males in childhood and females in adulthood)
What are modifiable risk factors associated with asthma?
-lower socioeconomic status
-exposure to second-hand smoke
-respiratory syncytial virus exposure
-reduced exposure to childhood infectious agents
What is the hygiene hypothesis?
Basically if you keep your kid too clean and don't allow it to do shit, it will never be exposed to things that will strengthen it's immune system. Then when it finally is exposed, it's immune system is so weak which makes it harder to fight infections.
What type of cells cause the inflammation in asthma?
What are factors that can trigger asthma symptoms?
-respiratory tract infections
Explain why asthma makes it hard for a patient to breathe.
The muscles of the bronchial tubes tighten and thicken and the air passages become inflamed and mucous-filled, making it hard for air to move.
What are the hallmarks of asthma pathology?
2. airway inflammation
3. airway remodelling
4. some degree of airflow obstruction
-increased tendency of bronchospasm
-exposure to irritants can trigger great spasmodic rxn
What type of antibodies bind to receptors on mast cells which produce inflammation?
After all the inflammation occurs, Type 2 helper cells are activated which produce ??
B cell activation which makes more IgE antibodies
What does chronic airway inflammation result from?
repeated exposure to the allergen
* we don't want this bc it can lead to other lung probs
Explain mast cells.
-found in walls of respiratory tract
-increased number in pt's with allergic asthma
-when exposed to allergen - mast cell degranulation
-allergen binds to IgE then mast cells release:
-bronchoconstrictors (histamine, leukotrienes, etc.)
-eosinophil and neutrophil chemotactic factors (attract more mast cells to area to make it worse)
-once activated they release inflammatory mediators such as leukotrienes and granule proteins to injure airway tissue
-release cytokines that mediate the allergic rxn
-increase TH2 activity
-scavengers that engulf and digest bacteria
-release inflammatory mediators such as platelets activated factor and leukotrienes
-release neutrophil chemotactic factor and eosinophil chemotactic factor which amplify the inflammatory process
Explain epithelial cells
-can be activated by IgE dependent mechanisms, viruses, pollutants, histamine
-normally - clear mucocilliary and removal of noxious agents but in chronic asthma - epithelial shedding occurs
What are 3 types of inflammatory mediators?
-PAF (platelet activating factor)
-released by lung mast cells
-induces smooth muscle constriction and bronchospasm
Describe arachadonic cells
Mast cells activate arachidonic cells to form:
-prostaglandin D2 and F2 (bronchoconstrictors)
-thromboxane (bronchoconstriction, airway inflammation, and BHR)
-mediation of bronchospasm, inflammation, anaphylaxis, etc.
What is PAF produced by?
neutrophils, monocytes, and macrophages
How are leukotrienes formed?
arachidonic acid metabolized by 5-lipooxygenase (5-LO) to form leukotrienes
What does excess production of leukotrienes cause?
bronchospasm and promote histamine release from mast cells
leukotrienes are ____
* they also increase mucous production which reduces clearance of aggravating allergen
T or F: it is ok to give Cox 1 inhibitors to asthmatics
FALSE - as Namaka said - you might as well give up your license now if you're gonna do that lol
Can never give Cox 1 inhibitors such as aspirin or ibuprofen to asthmatics!!!!
*Be sure to see slide 32
T or F: a cox 2 inhibitor helps with asthma
T or F: a leukotriene inhibitor will help with asthma
T or F: 5-LO inhibitors are used in treating asthma
False. (As dwight k. schrute would say it) - used for allergic rhinitis and nasal congestion
T or F: antihistamines help in treating asthma
What is the #1 cause of COPD in adults?
What is airway remodelling?
altered repair process in response to chronic inflammation leading to fibrosis and increase in smooth muscle cells, number of blood vessels, and increase in mucous glands
What factors lead to varying degrees of airway obstruction?
-smooth muscle of airways
-neuronal control and neurogenic inflammation
What does ACh cause?
T or F: an anticholinergic will treat asthma
True - it will cause bronchodilation making it easier for air to pass through
Norepinephrine affects alpha receptors which causes ?
Epinephrine affects beta receptors which causes ?
* Therefore you would never want to use a beta blocker on an asthmatic because it will prevent bronchodilation making it harder for the pt to breathe.
Would an alpha agonist be used in asthma?
Would a beta agonist be used in asthma?
Would smooth muscle relaxants be used in asthma?
Are corticosteroids used in asthma?
Yes - steroids reduce inflammation and swelling
When are oral corticosteroids used?
In acute asthma attacks
When are inhaled corticosteroids used?
Used for prophylactic control of asthma
*prophylactic means it is intended to prevent disease
How is asthma diagnosed?
-measurement of lung function
-peak expiratory flow rate
-airway responsiveness testing
-allergy testing to assess for triggers
What two things can be measured through spirometry that we talked about in class?
What is FVC?
Forced vital capacity - volume delivered during an expiration made as forcefully and completely as possible starting from fully inspired
What is FEV1?
Forced expiratory volume in 1 second - volume delivered in the first second of an FVC manoevre
What ratio do we care about that is used to measure airflow limitation?
normal is greater than or equal to 0.70 (70%)
less than 70% ratio indicates there is some form of airway obstruction
What is PEF? What does it measure?
Peak Expiratory Flow - measures maximum speed of expiration
-expressed as L/min
*useful mainly for monitoring therapy
What are some asthma triggers?
What are the 2 parts to pharmacologic therapy for asthma?
1. Relievers - use as needed to quickly reverse bronchoconstriction and relieve symptoms
2. Controllers (prophylactic medications used to prevent the disease) - inhaled steroids - use daily to prevent symptoms and flare ups
What are symptoms of an asthma episode?
-dyspnea (trouble breathing)