Asthma

Question 1

Syndrome characterized by airflow obstruction that varies markedly, both spontaneously and with treatment

Answer 1

Asthma

Question 2

Heterogenous disease characterized by chronic airflow inflammation that varies markedly both spontaneously and w/ treatment

Answer 2

Asthma

Question 3

Asthma

Answer 3

AIRWAY HYPERRESPONSIVENESS

AIRFLOW INFLAMMATION

Question 4

Measures how much air an individual can EXHALE during a forced breath during the first second

Answer 4

FEV 1

Question 5

Total amount of air exhaled during the FEV test

Answer 5

FVC

Question 6

Should be 75-80 %
REDUCED in obstructive diseases
May be NORMAL or INCREASED in restrictive diseases

Answer 6

FEV 1/FVC ratio

Question 7

Major risk factor for asthma

Answer 7

atopy

Question 8

Most consistent findings in asthma have been associated with polymorphisms of genes on

Answer 8

chromosome 5q

Question 9

Hygiene hypothesis

Answer 9

Proposes that LACK OF INFECTIONS in early childhood PRESERVES THE TH2 CELL BIAS at birth whereas EXPOSURE TO INFECTIONS and endotoxin results in a shift toward a predominant PROTECTIVE TH1 IMMUNE RESPONSE

Question 10

Mast cells

Answer 10

Important in initiating the ACUTE BRONCHOCONSTRICTION responses to allergens and several other indirectly acting stimuli (exercise, hyperventilation and fog)

Question 11

Dendritic cells

Answer 11

Specialized macrophage-like cells in the airway epithelium which are major antigen presenting cells –

Question 12

Characteristic feature of asthma airways

Answer 12

Eosinophil infiltration

Question 13

Eosinophils

Answer 13

Linked to the development of AHR through the release of basic proteins and oxygen derived free radicals

Question 14

Neutrophils

Answer 14

Resistant to the anti-inflammatory effects of corticosteroids

Question 15

T-lymphocytes

Answer 15

Play a very important role in coordinating the inflammatory response in asthma through the release of specific cytokines

Question 16

IL-4, IL-5 and IL-13

Answer 16

Mediate allergic inflammation

Question 17

Chemokines

Answer 17

Involved in ATTRACTING INFLAMMATORY CELLS from the bronchial circulation into the airways

Question 18

TNF-α and IL-1β

Answer 18

Proinflammatory cytokines that amplify the inflammatory response and has a role in SEVERE DISEASE

Question 19

IL-13

Answer 19

Induces MUCUS HYPERSECRETION

Question 20

Airway remodeling

Answer 20

Increased airway smooth muscle, fibrosis, angiogenesis and mucus hyperplasia

Question 21

Major pathology of asthma

Answer 21

airway hyperresponsiveness

Question 22

Symptoms of Asthma

Answer 22

wheezing
shortness of breath
chest tightness
cough

Question 23

2 key defining features of asthma

Answer 23

history of respiratory symptoms such as wheeze, SOB, chest tightness and cough that vary over time and intensity

AND

variable expiratory airflow limitation

Question 24

Most frequent PE finding in px with asthma

Answer 24

wheezing on auscultation esp on forced expiration

Question 25

Provide quick relief of asthma symptoms and bronchoconstriction

Answer 25

SABA - Salbutamol (Albuterol), Terbutaline

Question 26

Adverse effects of SABA

Answer 26

``` tremor tachycardia (palpitations) hyperglycemia hypokalemia hypomagnesemia restlessness hypoxemia ```

Question 27

Preferred reliever for patients prescribed as-needed controller therapy for mild asthma

Answer 27

Low dose ICS (Budesonide)-Formoterol

Question 28

Adverse effects of LABA – Formoterol, Salmeterol

Answer 28

tachycardia headache cramps

Question 29

Adverse effects of SAMA (Ipratropium bromide, Oxitropium bromide)

Answer 29

dry mouth (MC) bitter taste glaucoma urinary incontinence

Question 30

The most effective anti-inflammatory medications for asthma

Answer 30

Inhaled corticosteroids (ICS) – Beclomethasone, Budesonide, Ciclesonide, Fluticasone propionate, Fluticasone furoate, Mometasone, Triamcinolone

Question 31

Local adverse effects of ICS

Answer 31

oropharyngeal candidiasis | hoarseness/dysphonia

Question 32

Systemic side effects of ICS

Answer 32

osteoporosis glaucoma cataract

Question 33

Adverse effects of LAMA (Tiotropium bromide)

Answer 33

dry mouth

Question 34

Anti IgE that neutralizes circulating IgE without binding to cell-bound IgE

Answer 34

Omalizumab

Question 35

An add-on option for px with SEVERE ALLERGIC ASTHMA uncontrolled on high dose ICS-LABA

Answer 35

Anti-IgE - Omalizumab

Question 36

An add-on option for px with SEVERE EOSINOPHILIC ASTHMA uncontrolled on high dose ICS-LABA

Answer 36

Anti-IL5- Mepolizumab or Reslizumab and anti-IL5R - BenRalizumab

Question 37

An add-on option for px with SEVERE EOSINOPHILIC OR TYPE 2 ASTHMA uncontrolled on high dose ICS-LABA

Answer 37

Anti-IL4R – Dupilumab

Question 38

Short term adverse effects of oral corticosteroids – prednisone, prednisolone, methylprednisolone, hydrocortisone

Answer 38

``` sleep disturbance reflux appetite increase hyperglycemia mood changes ```

Question 39

Long term adverse effects of oral corticosteroids

Answer 39

``` cataract glaucoma hypertension diabetes adrenal suppression osteoporosis ```

Question 40

Preferred reliever for step 1 and 2

Answer 40

as needed LOW DOSE ICS-FORMOTEROL other reliever SABA

Question 41

Preferred reliever for step 1 and 2

Answer 41

as needed LOW DOSE ICS-FORMOTEROL other reliever SABA

Question 42

Preferred controller for step 1

Answer 42

as needed LOW DOSE ICS FORMOTEROL other controller options LOW DOSE ICS taken whenever SABA is taken

Question 43

Preferred controller for step 2

Answer 43

daily LOW DOSE ICS or as needed LOW DOSE ICS-FORMOTEROL other controller options daily LTRA OR LOW DOSE ICS taken whenever SABA is taken

Question 44

Preferred reliever for step 3,4 and 5

Answer 44

as needed low dose ICS - formoterol for patients prescribed maintenance

Question 45

Preferred controller for step 3

Answer 45

LOW DOSE ICS-LABA other controller options MEDIUM DOSE ICS or LOW DOSE ICS +/- LTRA

Question 46

Preferred controller for step 4

Answer 46

MEDIUM DOSE IC-LABA other controller options HIGH DOSE ICS, add on TIOTROPIUM or add on LTRA

Question 47

Preferred controller for step 5

Answer 47

HIGH DOSE ICS LABA refer for phenotypic assessment +/- add on therapy i.e. tiotropium, anti IgE, anti IL5/5R, anti IL4R other controller options add LOW DOSE OCS

Question 48

SABA stimulate adenycyl cyclase --> inc cAMP --> bronchodilation

Answer 48

Procaterol Salbutamol Terbutaline Albuterol

Question 49

Adverse effects of SABA

Answer 49

tremor palpitation mild hypokalemia

Question 50

SAMA (-) cholinergic reflex components

Answer 50

Ipratropium

Question 51

Adverse effects of SAMA

Answer 51

dry mouth urinary retention glaucoma

Question 52

Methylxanthines (-) PDE activity --> inc cAMP --> bronchodilation

Answer 52

Theophylline Aminophylline Doxofylline

Question 53

ICS

Answer 53

Beclomethasone Budesonide Fluticasone

Question 54

Adverse effects of ICS

Answer 54

hoarseness dysphonia oral candidiasis pneumonia

Question 55

Systemic Steroids

Answer 55

Prednisone Methylprednisone Hydrocortisone

Question 56

Adverse effects of systemic steroids

Answer 56

``` truncal obesity easy bruisability osteoporosis DM HPN ulcers proximal myopathy cataracts depression ```

Question 57

LABA should NOT be given in the absence of ICS

Answer 57

``` Formoterol Salmeterol Bambuterol Vilanterol Indacaterol Olodaterol ```

Question 58

LAMA blocks acetylcholine's effects on muscarinic receptors

Answer 58

Tiotropium

Question 59

Leukotriene Modifying Drugs

Answer 59

BLOCK LEUKOTRIENE RECEPTORS Montelukast Zafirlukast INHIBIT LIPOXYGENASE Zileuton

Question 60

Cromones (-) mast cells and sensory nerve activation

Answer 60

Cromolyn sodium | Nedocromil sodium

Question 61

Anti-IgE

Answer 61

Omalizumab