asthma

Question 1

symptoms

Answer 1

• wheeze
• chest tightness
• cough
• shortness of breath (worse at night)

Question 2

when does it occur

Answer 2

between 3-5 years old

Question 3

what are the 3 characteristics

Answer 3

• airflow limitation
• airway hyper-responsiveness
• bronchial inflammation

Question 4

is airflow limitation reversible

Answer 4

yes

may need treatment to do so

Question 5

what is present in bronchial inflammation

Answer 5

• T lymphocytes
• mast cells
• eosinophils m
• oedema
• smooth muscle hypertrophy
• mucus plugging
• epithelial damage

Question 6

what is the skin prick test result

Answer 6

positive to common inhalant allergens such as dust mite, animal danders, pollens and fungi

Question 7

what is childhood asthma often accompanied by

Answer 7

eczema

Question 8

what can be a cause of late onset asthma

Answer 8

sensitisation to chemicals or biological products in the workplace

Question 9

what can cause non-atopic asthma in middle age

Answer 9

• sensitisation to occupation agents
• intolerance to NSAIDs (aspirin)
• prescription of beta-adrenoreceptor blockers

Question 10

causes

Answer 10

• grass pollen
• domestic pets
• rhinovirus
• cold air
• emotion
• perfume
• cigarette smoke
• NSAIDs
• Beta blockers
• genetics

Question 11

what does term atopy include

Answer 11

asthma and hayfever

Question 12

atopic diseases are those that

Answer 12

• run in families
• skin reactions to common allergens
• circulating allergen-specific antibodies (IgE)

Question 13

what is elevated serum IgE linked to in asthma

Answer 13

airway hyper-responsiveness

Question 14

what genes control cytokine production

Answer 14

• IL-3
• IL-4
• IL-5
• IL-9
• IL-13

these affect mast cell development and eosinophils

Question 15

what helper cells are involved in asthma

Answer 15

type 2 helper cells

Question 16

how can airway hyper-responsiveness be demonstrated

Answer 16

ask patient to inhale gradually increasing concentrations of histamine or methacholine

aka bronchial provocation test

Question 17

what would the bronchial provocation test be in asthmatic patient

Answer 17

they would respond to a very low dose of methacholine

Question 18

what other conditions would react to methacholine

Answer 18

• wheezing with viral infection
• seasonal wheeze
• allergic rhinitis

Question 19

what increases the risk of developing some forms of occupational asthma

Answer 19

smoking

Question 20

when do asthmatics usually wheeze

Answer 20

after prolonged exercise or inhalation of cold, dry air (air conditioning included)

Question 21

what is exercise induced wheeze driven by

Answer 21

release of histamine, prostaglandins and leukotrienes from mast cells

Question 22

what can asthmatics experience worsening of symptoms

Answer 22

• exposure to tobacco smoke
• car exhaust fumes
• solvents
• strong perfumes

Question 23

what drugs implicate asthma

Answer 23

NSAIDs

particularly aspirin

Question 24

what do NSAIDs inhibit

Answer 24

arachidonic acid metabolism via the cyclo-oxygenase (COX) pathway

Question 25

what is there a reduction of in aspirin intolerant asthma

Answer 25

reduce production of PGE2 leads to overproduction of cysteinyl leukotrienes by eosinophils, mast cells and macrophages

Question 26

COX-2 inhibitors trigger asthma attacks true or false

Answer 26

false only COX-1 do

Question 27

what drug contraindicates asthma and should never be given to patient

Answer 27

beta blocker

Question 28

what is the inflammatory component of asthma driven by

Answer 28

Th2 T lymphocytes

Question 29

what response occurs when there is a decrease in sensitivity to corticosteroids

Answer 29

Th1 response with release of mediators such as TNF-alpha

Question 30

where is there an increase in mast cells in asthma

Answer 30

- epithelium - smooth muscle - mucous glands

Question 31

what do mast cells release in asthma

Answer 31

- histamine - tryptase - PGD2 - cysteinyl leukotrienes cause immediate asthmatic reaction

Question 32

where are eosinophils found in asthma

Answer 32

in bronchial wall and secretions

Question 33

how are eosinophils attracted to the airways

Answer 33

by cytokines: - IL-3 - IL-5 - GM-CSF

Question 34

what do eosinophils release when activated

Answer 34

LTC4

Question 35

what drug can decrease activation of eosinophils

Answer 35

corticosteroids

Question 36

epithelium changes

Answer 36

- loss of ciliated columnar cells

Question 37

what is epithelium a major source of

Answer 37

- mediators - cytokines - growth factors these enhance inflammation and promote tissue remodelling

Question 38

what is a useful test for continuing inflammation

Answer 38

measurement of exhaled NO

Question 39

what is smooth muscle like

Answer 39

hyperplasia

Question 40

what happens to the smooth muscle

Answer 40

- contracts more easily | - remains contracted

Question 41

what do smooth muscle secretes

Answer 41

- cytokines - chemokines - growth factors

Question 42

what does acetycholine stimulate

Answer 42

M3

Question 43

symptoms

Answer 43

- wheezing - SOB (episodic) - worse during night - cough

Question 44

what can be done for diagnosis

Answer 44

- PEFR - spirometry - exercise test - CXR - skin prick

Question 45

how is PEFR done

Answer 45

- measure on walking before bronchodilator use | - measure in bed after bronchodilator m

Question 46

what does PEFR show

Answer 46

the diurnal variability

Question 47

how does spirometry show ashtma

Answer 47

greater than 15% improvement in FEV1 following bronchodilator use

Question 48

what is used for diagnosis in children

Answer 48

exercise test

Question 49

how is exercise test done

Answer 49

run for 6 minutes on treadmill

Question 50

what can be seen on CXR

Answer 50

- overinflation

Question 51

treatment for occasional symptoms not everyday

Answer 51

SABA

Question 52

treatment for daily symptoms

Answer 52

corticosteroid

Question 53

treatment for severe symptoms

Answer 53

corticosteroid + LABA if not controlled add either leukotriene or theophylline

Question 54

treatment for severe symptoms that are uncontrolled on high dose corticosteroid

Answer 54

increase corticosteroid + LABA | + leukotriene/theophylline

Question 55

treatment for severe symptoms with patient deteriorating

Answer 55

corticosteroid + prednisolone

Question 56

treatment for severe symptoms and continued deterioration on prednisolone

Answer 56

hospital admission

Question 57

example of SABA

Answer 57

salbutamol

Question 58

example of LABA

Answer 58

salmeterol

Question 59

example of corticosteroid

Answer 59

beclometasone budesonide fluticasone

Question 60

example of leukotriene

Answer 60

monelukast | zafirlukast

Question 61

when can drugs be reassessed

Answer 61

2-3 months after under control

Question 62

what do beta adrenoreceptor agonist do

Answer 62

affect B2 only | - relax the bronchial smooth muscle

Question 63

can LABAs be given on their own

Answer 63

no

Question 64

what are LABAs given with

Answer 64

corticosteroids

Question 65

what does sodium cromoglicate prevent

Answer 65

activation of many inflammatory cells, particularly mast cells, eosinophils and epithelial cells

Question 66

SE of inhaled corticosteroids

Answer 66

- oral candidiasis - hoarseness - osteoporosis

Question 67

drug against IgE

Answer 67

omalizumab

Question 68

features of life threatening attack

Answer 68

- silent chest - exhaustion - bradycardia

Question 69

drugs used for acute severe asthma

Answer 69

- SABA - antimuscarinic - magnesium sulphate - hydrocortisone - predisolone - ventilation

Question 70

order of treatment for acute severe asthma

Answer 70

1. oxygen 2. salbutamol 3. ipatropium 4. hydrocortisone 5. prednisolone 6. magensium sulphate IV