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Phase 2a Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is happening to the incidence of asthma?

A

It is increasing

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2
Q

What is happening to the incidence of asthma?

A

It is increasing

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3
Q

What are the two main classifications of asthma?

A

Eosinophilic and non-eosinophilic

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4
Q

What is Eosinophilic asthma split into?

A

Intrinsic and extrinsic asthma

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5
Q

What is intrinsic asthma?

A

Rare + adult presentation

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6
Q

Who is commonly affected by extrinsic asthma?

A

Children - but adult presentation can occur (occupation)

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7
Q

What is extrinsic asthma associated with?

A

Atopy

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8
Q

What atopic conditions might someone with asthma have a PMHx or FHx of?

A

allergic rhinitis (hayfever), atopic eczema (atopic dermatitis)

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9
Q

What is asthma described as?

A

A chronic condition of the airways - reversible airways obstruction

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10
Q

How does asthma differ from COPD?

A

Reversible

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11
Q

What are the 3 features seen in asthma pathology?

A

Airway narrowing, Airway hyper-responsiveness (to Ag), airway remodelling

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12
Q

What are the 3 pathological features that cause airway narrowing?

A

Bronchoconstriction (SM contraction), mucosal swelling + inflammation (mucosal oedema), and ^ mucous production

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13
Q

What is airway hyper-responsiveness?

A

An abnormal response to an inhaled Ag causing unnecessary effects

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14
Q

What are the 3 features that occur in airway remodelling in asthma?

A

^ no. of goblet cells (metaplasia - loss of columnar cells), airway SM hypertrophy/hyperplasia and thickened BM (by collagen deposition)

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15
Q

What is Gell and Coomb’s classification for?

A

classifying pathological reactions into hypersensitivity reactions

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16
Q

What type of hypersensitivity reaction is atopic asthma?

A

Type 1 (IgE mediated)

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17
Q

What type of hypersensitivity reaction is occupational asthma?

A

Type 3 (according to Kim Suvana)

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18
Q

What occurs immunologically in asthma to cause bronchoconstriction and the other pathological features?

A

An APC presents allergen to a naive T cell –> activation –> Th2 cell –> releases IL-4 + 13 which activates a B cell –> releases IgE –> Mast cell degranulation

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19
Q

What type of T cell is involved in the asthma pathophysiology?

A

Th2

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20
Q

Does Th2 also activate Mast cells directly?

A

Yes (releases IL-4 + IL-9)

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21
Q

What is released in mast cell degranulation?

A

Histamine + Leukotrienes

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22
Q

What is the effect of histamine?

A

^ vascular permeability (oedema), goblet mucus ^ secretion, SM contraction

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23
Q

What is the effect of Leukotrienes?

A

potent bronchoconstrictors

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24
Q

What are the symptoms of asthma?

A

Wheeze, tight chest, dry cough, SOB

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25
What is special about asthma symptoms?
Diurnal variation (worse at night + early morning)
26
Why might there be diurnal variation?
^ in mast cells at night
27
When are the signs of asthma seen?
During an asthma attack
28
What signs can be seen during an asthma attack?
Hyperinflated chest, bilateral expiratory wheeze, ^ RR, ^ HR, cyanotic, ^ use of expiratory muscles, nostril flaring, tachypnoea
29
What might happen t a person during an asthma attack?
Not be able to talk
30
What might trigger the symptoms of asthma?
Occupation, cold, exercise, emotion/stress, infections, drugs (NSAIDs + beta blockers)
31
What is the feature of occupational asthma?
Symptoms improve when away from work
32
What should you ask in a Hx from a patient with asthma?
Triggers (cold, pets, allergies, drugs?), hx/FHx of atopy, diurnal variation, smoking status, frequency of symptoms, triggers at work? occupation?
33
What 4 investigations might you decide to carry out on someone with suspected asthma?
PEFR, Spirometry, histamine + methacholine challenge, skin prick test
34
What would you see in spirometry for someone with asthma?
Airways obstruction: FEV1/FVC
35
What would you see in PEFR for someone with asthma?
Decreased (as ^ time to exhale air) + diurnal variation
36
What would you see in histamine/methacoline challenge in someone with asthma?
Hyper-responsive airways
37
What would you see in skin prick test in someone with asthma?
Atopy
38
What is the conservative management for someone with asthma?
Education (ensure good inhalor technique, ACTION plan, regular PEFR monitoring), avoid precipitating factors, smoking cessation, influenza vaccine
39
What is the first step in the management of chronic asthma? What PEFR is this?
SABA (salbutamol)
40
What is the second step in the management of chronic asthma?
Add an inhaled corticosteroid (beclamethasone)
41
Give an example of an inhaled corticosteroid
Beclamethasone
42
What is the 3rd step in the management of chronic asthma?
Add a LABA (salmeterol)
43
What might you consider if SABA, ICS and LABA isn't working?
increase the dose of the ICS or add a LTRA (leukotriene receptor antagonist)
44
Give an example of a leukotriene receptor antagonist
Montelukast
45
What might you consider if LTRA doesn't work in controlling asthma symptoms?
Oral prednisolone + refer to asthma clinic
46
What PEFR value indicates the use of oral prednisolone + referral to asthma clinic?
PEFR
47
When do you move from step 1-2 in the management of chronic asthma?
PEFR
48
What PEFR value indicates that an asthma patient should be admitted to hospital?
49
When should you review the treatment plan for asthma?
Every 3months
50
What mAb can you consider in severe asthma cases?
Omalizumab (IgE receptor antagonist)
51
What is the advantage of inhaled corticosteroids over oral corticosteroids?
Less systemic affects
52
What is a SE of inhaled corticosteroids?
Oral thrush (candidiasis)
53
What is the treatment steps for someone suffering an acute asthma attack?
Salbutamol + oral corticosteroid --> salbutamol inhaler --> O2 therapy + IV salbutamol ...etc
54
What are the two main classifications of asthma?
Eosinophilic and non-eosinophilic
55
What is Eosinophilic asthma split into?
Intrinsic and extrinsic asthma
56
What is intrinsic asthma?
Rare + adult presentation
57
Who is commonly affected by extrinsic asthma?
Children - but adult presentation can occur (occupation)
58
What is extrinsic asthma associated with?
Atopy
59
What atopic conditions might someone with asthma have a PMHx or FHx of?
allergic rhinitis (hayfever), atopic eczema (atopic dermatitis)
60
What is asthma described as?
A chronic condition of the airways - reversible airways obstruction
61
How does asthma differ from COPD?
Reversible
62
What are the 3 features seen in asthma pathology?
Airway narrowing, Airway hyper-responsiveness (to Ag), airway remodelling
63
What are the 3 pathological features that cause airway narrowing?
Bronchoconstriction (SM contraction), mucosal swelling + inflammation (mucosal oedema), and ^ mucous production
64
What is airway hyper-responsiveness?
An abnormal response to an inhaled Ag causing unnecessary effects
65
What are the 3 features that occur in airway remodelling in asthma?
^ no. of goblet cells (metaplasia - loss of columnar cells), airway SM hypertrophy/hyperplasia and thickened BM (by collagen deposition)
66
What is Gell and Coomb's classification for?
classifying pathological reactions into hypersensitivity reactions
67
What type of hypersensitivity reaction is atopic asthma?
Type 1 (IgE mediated)
68
What type of hypersensitivity reaction is occupational asthma?
Type 3 (according to Kim Suvana)
69
What occurs immunologically in asthma to cause bronchoconstriction and the other pathological features?
An APC presents allergen to a naive T cell --> activation --> Th2 cell --> releases IL-4 + 13 which activates a B cell --> releases IgE --> Mast cell degranulation
70
What type of T cell is involved in the asthma pathophysiology?
Th2
71
Does Th2 also activate Mast cells directly?
Yes (releases IL-4 + IL-9)
72
What is released in mast cell degranulation?
Histamine + Leukotrienes
73
What is the effect of histamine?
^ vascular permeability (oedema), goblet mucus ^ secretion, SM contraction
74
What is the effect of Leukotrienes?
potent bronchoconstrictors
75
What are the symptoms of asthma?
Wheeze, tight chest, dry cough, SOB
76
What is special about asthma symptoms?
Diurnal variation (worse at night + early morning)
77
Why might there be diurnal variation?
^ in mast cells at night
78
When are the signs of asthma seen?
During an asthma attack
79
What signs can be seen during an asthma attack?
Hyperinflated chest, bilateral expiratory wheeze, ^ RR, ^ HR, cyanotic, ^ use of expiratory muscles, nostril flaring, tachypnoea
80
What might happen t a person during an asthma attack?
Not be able to talk
81
What might trigger the symptoms of asthma?
Occupation, cold, exercise, emotion/stress, infections, drugs (NSAIDs + beta blockers)
82
What is the feature of occupational asthma?
Symptoms improve when away from work
83
What should you ask in a Hx from a patient with asthma?
Triggers (cold, pets, allergies, drugs?), hx/FHx of atopy, diurnal variation, smoking status, frequency of symptoms, triggers at work? occupation?
84
What 4 investigations might you decide to carry out on someone with suspected asthma?
PEFR, Spirometry, histamine + methacholine challenge, skin prick test
85
What would you see in spirometry for someone with asthma?
Airways obstruction: FEV1/FVC
86
What would you see in PEFR for someone with asthma?
Decreased (as ^ time to exhale air) + diurnal variation
87
What would you see in histamine/methacoline challenge in someone with asthma?
Hyper-responsive airways
88
What would you see in skin prick test in someone with asthma?
Atopy
89
What is the conservative management for someone with asthma?
Education (ensure good inhalor technique, ACTION plan, regular PEFR monitoring), avoid precipitating factors, smoking cessation, influenza vaccine
90
What is the first step in the management of chronic asthma? What PEFR is this?
SABA (salbutamol)
91
What is the second step in the management of chronic asthma?
Add an inhaled corticosteroid (beclamethasone)
92
Give an example of an inhaled corticosteroid
Beclamethasone
93
What is the 3rd step in the management of chronic asthma?
Add a LABA (salmeterol)
94
What might you consider if SABA, ICS and LABA isn't working?
increase the dose of the ICS or add a LTRA (leukotriene receptor antagonist)
95
Give an example of a leukotriene receptor antagonist
Montelukast
96
What might you consider if LTRA doesn't work in controlling asthma symptoms?
Oral prednisolone + refer to asthma clinic
97
What PEFR value indicates the use of oral prednisolone + referral to asthma clinic?
PEFR
98
When do you move from step 1-2 in the management of chronic asthma?
PEFR
99
What PEFR value indicates that an asthma patient should be admitted to hospital?
100
When should you review the treatment plan for asthma?
Every 3months
101
What mAb can you consider in severe asthma cases?
Omalizumab (IgE receptor antagonist)
102
What is the advantage of inhaled corticosteroids over oral corticosteroids?
Less systemic affects
103
What is a SE of inhaled corticosteroids?
Oral thrush (candidiasis)
104
What is the treatment steps for someone suffering an acute asthma attack?
Salbutamol + oral corticosteroid --> salbutamol inhaler --> O2 therapy + IV salbutamol ...etc

Phase 2a Respiratory (11 decks)

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