what is asthma
a long term respiratory condition in which airways may unexpectedly and suddenly narrow in response to an allergen, cold air, exercise, or stress.
symptoms of asthma
wheezing, shortness of breath, chest tightness, coughing
what is COPD
chronic bronchitis and emphysema, a pair of two commonly coexisting diseases of the lungs in which the airways become narrowed.
symptoms of COPD
limitation of flow of air to and from the lungs causing shortness of breath
Asthma results from what and what are mediators of asthmas
asthma is a disease resulting from an excessive active immune system and attenuation of the immune response is important for treatment!
T effector cells are mediators
Th cells determine course of inflammation
sequence of events leading to infiltration of eosinophils in the lung
allergen > mast cell > Th2 > infiltration of eosinophils
what mediates an inflammatory response in eosinophilic asthma leading to eosinophil infiltration of the lung
Th2 cells by the virtue of cytokines
Aspects of Th1
cell mediated immunity, intracellular pathogens, against yeast, viruses, intracellular bacteria, and cancer
Aspects of Th2
humoral/ AB mediated immunity, extracellular pathogens, parasites, normal bacteria, toxins, and allergens
what regulates the balance between Th1 and Th2
cytokines!
what is atopy
Atopy is the prediposition to Th2 responses - frequently linked to asthma
Explain eosinophilic asthma and what is used to treat them
eosinophils and basement membrane thickening treated by Inhalational corticosteroids
Explain Non eosinophilic asthma
no eosinophils, no Basement membrane thickening. Treatments still needed
Th1 asthma
chronic inflammatory autoimmune disorders
Th2 asthma
allergic (atopic) disorders > eosinophilic asthma
Th17 asthma
Th17 asthma is chronic inflammatory and autoimmune disorder > neutrophilic asthma
goals of asthma treatment
- relieve/ prevent bronchoconstriction
- inhibit airway inflammation - RED mucus production
- prevent airway remodeling
Goal: manage disease so symptoms are minimized
Asthma onset
allergic response:
with treatment
late stage inflammation leads to what
onset: typically during childhood or adolescence
allergic response: bronchoconstriction
Treatment: near normal lung function and symptom free life possible
Late stage inflammation usually involves eosinophil recruitment
COPD Onset: bronchoconstriction from: Treatment: Inflammation involves
Onset: typically in smokers and former smokers in 40s
bronchoconstriction results from change in vagal tone
treatment: PTs still experience symptoms, airflow obstruction is only partially reversible
Inflammation: involves neutrophil recruitment (neutrophilia)
drug classes TX for allergic rhinitis
H1 receptor antagonists (antihistamines)
A1-adrenergic receptor agonists (decongestants)
and intranasal corticosteroids
What does nasal corticosteroids do
reduce swelling and inflammation in mucous membranes and reduce mucus production
side effects of nasal corticosteroids
rare but irritation, bad taste, nose bleeds, and sores in nose and perforation of nasal septum can occur
what are oral decongestants
A1 adrenergic receptor agonists that constrict blood vessels and relive congestion
two oral decongestants
phenylephrine- low bioavailability
pseudoephrine - particularly effective for nasal membranes, can be alone or with anti-histamines and pain relievers
side effects of oral decongestants
tachycardia, hypertension, CNS stimulation, tremors
what are antihistamines
antihistamines are H1 antagonist
what are oral antihistamines used for
for systemic or local relief
what are topical antihistamines used for
topical = urticaria (hives)
what are ophthalmic antihistamines used for
for eye allergies
what are intranasal antihistamines used for
for seasonal rhinitis
Describe 1st generation antihistamines
1st generation antihistamines had significant entry into brain, sedative effect, anti -emetic, anti motion sickness effects
describe 2nd generation antihistamines
limited entry into brain, more selective, fewer adverse effects
name some common 1st ten antihistamines and their main drawbacks
benadryl, nyquil, dramamine
PRODUCE Drowsiness! short half lives and cross BBB
what does Histamine receptor activity on vascular endothelium do
INC intracellular Ca leading to NO mediated relaxation of smooth m and vasodilation
what produces broncho constriction in asthma
contents of mast cells granulation such as histamine, cystidinyl leukotrienes, prostaglandins
agent INC Ca in smooth m will act as what
Agents Dec Ca in smooth m will act as what
INC Ca= broncho constrictors
Dec Ca= broncho dilators
what produces relaxation of smooth m
B2 adrenergic receptor agonists