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Respiratory Exam 1 > Asthma > Flashcards

Asthma Flashcards

1
Q

3 cardinal features of asthma

A
  • airway inflammation
  • reversible airflow obstruction
  • airway hyper responsiveness
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2
Q

why are lungs hyper inflated in asthma

A
  • mucus is obstructing the airway lumen and air cannot get out.
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3
Q

T2 high asthma phenotypes secrete

A
  • IL-4,5,13
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4
Q

aspirin exacerbated respiratory disease characterized by

A
  • asthma
  • recurrent sinus with nasal polyps
  • sensitivity to aspirin and other NSAIDS
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5
Q

pathology of allergic asthma

A
  • dendritic cells infiltrate airway and sample antigens in airway lumen
  • dendritic cells migrate to regional lymph nodes and present to T cells.
  • T cells differentiate into Th2 and produce IL-4, 5, 13
  • IL-4 cause B lymphocytes to switch to IgE
  • IgE antibodies bind to mast cells
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6
Q

how are mast cells activated in allergic asthma

A
  • 2 IgE antibodies on mast cell bind antigen
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7
Q

result of mast cell activation in allergic asthma

A
  • rapid synthesis of arachadonic acid metabolites (prostaglandins and leukotrienes)
  • synthesis of pro-inflammatory cytokines
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8
Q

result of pro-inflammatory mediators in allergic asthma

A
  • airway smooth muscle - bronchoconstriction
  • blood vessels - vasodilation and increased permeability
  • epithelial cells - mucous cell metaplasia (mucous cells where they shouldn’t be)
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9
Q

how do eosinophils get involved in asthma

A
  • IL-5 and eotaxin produced by Th2 lymphocytes and mast cells release eosinophils from bone marrow
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10
Q

result of eosinophils in allergic asthma

A
  • pro-inflammatory effects
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11
Q

what is a transcription factors in TH2 cells that is critical for production of TH2 cytokines IL-4,5,13

A
  • GATA-13
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12
Q

what is late-onset eosinophilic asthma associated with

what is it not associated with

A
  • associated with eosinophils

- not associated with allergy

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13
Q

non-allergic, late-onset eosinophilic asthma mediator

what do they react to

A
  • ILC2

- TSLP, IL-25, IL-33

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14
Q

result of stimulation of ILC2 in non-allergic, late-onset eosinophilic asthma

A
  • secretes IL-5 and IL-13
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15
Q

why is non-allergic, late-onset eosinophilic asthma referred to as non-allergic?

A
  • does not make IL-4 for IgE class switching

- and no mast cells involved

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16
Q

how does aspirin exacerbated respiratory disease work?

A
  • blocks cyclooxyrgenase

- shunts everything down leukotriene path (LTC4)

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17
Q

result of LTC4

A
  • vasodilate
  • increased capillary permeability
  • mucous cell metaplasia and mucous production
  • bronchoconstriction
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18
Q

Th17 cells involved in which asthma

airways domination is by

A
  • neutrophilic asthma

- neutrophils

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19
Q

Th-17 secretes which cytokines (and their role

A
  • IL-17 (recruit neutrophils)

- IL-21 (stimulates NK cells, B cells and Th17 cells)

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20
Q

between eosinophils and neutrophils, which is steroid responsive?

A
  • eosinophils
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21
Q

3 remodeling changes in asthmatic airways

A
  • basement membrane thickening from fibrosis
  • smooth muscle hyperplasia
  • mucous cell metaplasia
22
Q

MOA of albuterol

A
  • activates beta 2 adrenergic receptors on airway smooth muscle
  • increases intracellular cAMP
  • relaxes airway smooth muscle
23
Q

airflow obstruction in asthma results from narrowing of airway lumen and intraluminal obstruction by

24
Q

flow-volume curve in asthma

A
  • low peak expiratory flow

- scooped out appearance during expiration

25
FEV1 in asthma
- reduced FEV1
26
FVC is mild/moderate asthma why
- generally normal | - most air will eventually be exhaled
27
FEV1/FVC ratio in mild/moderate asthma
- reduced
28
FEV1 versus FVC in severe asthma impact on ratio
- FEV1 falls much greater than FVC | - so ratio is still low
29
DLCO in asthmatics
- normal or elevated
30
DLCO in COPD
- reduced
31
how do we see airway hyper responsiveness in asthmatics
- airways constrict even further after exposure to stimuli that do not affect caliber of airways in normal individuals
32
what is a good test to diagnose asthma in patients suspected of having asthma whose baseline spirometry is normal
- methacholine test
33
asthma symptoms
- cough - chest tightness - wheeze - dyspnea
34
wheezing is indicative of what airway obstruction
- lower airway obstruction
35
upper airway obstruction is indicative of what sound
- stridor
36
wheezing in heard on inspiration/expiration?
- expiration usually
37
stridor is heard on inspiration/expiration?
- both
38
skin symptoms of asthma
- eczema
39
upper airway symptoms of asthma
- enlarged nasal turbinates | - pale or inflamed nasal mucosa
40
symptoms of asthma during severe exacerbations
- accessory muscle use - intercostal retractions - decreased breath sounds
41
what is the clinical indication of a significant response in FEV1 post bronchodilator
- >12% improvement
42
how does the methacholine test work
- inhale methacholine and watch for drop in FEV1
43
what is PC20
- provocative concentration that causes FEV1 to fall by 20%
44
what is a gas also high in asthmatics
- exhaled nitric oxide
45
what would you look for in sputum of asthma
- eosinophils - Carcot-Leyden crystals - Curschmann's spirals - Creola bodies
46
what is the rescue medication for asthma treatment side effect what do you give if side effect is present
- albuterol sulfate - tachycardia - levalbuterol
47
MOA of nebulizer ipatropium
- anti-cholinergic - blocks M3 receptors on airway smooth muscle - blocks contraction
48
asthma patients are started on
- inhaled corticosteroids
49
if inhaled corticosteroid medications are insufficient, what do we give patients
- inhaled corticosteroids + long acting beta agonists
50
patients with severe airway obstructions who are mechanically ventilated with a high respiratory rate get what what will come next
- breath stacking - dynamic hyperinflation - auto peep
51
how auto peep causes cardiogenic shock
- increased intrathoracic pressure from auto-peep - increased RV afterload - decreased RV preload - decreased RV cardiac output - decreased LA and LV filling - cardiac shock
52
treatment for cardiogenic shock and auto peep in patients with obstructive airway disease
- remove from ventilator | - start vent at lower respiratory rate giving patient more time to exhale

Respiratory Exam 1 (27 decks)

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