Asthma (Newman) Flashcards
What is asthma?
- episodic or chronic Sx of airflow obstruction - reversibility of airflow obstruction, either spontaneously or following broncho dilator therapy
How is asthma diagnosed?
- limitation of airflow on pulmonary function testing OR - positive broncho-provocation challenge (methacholine challenge)
Clinical Sx of asthma (5)
- cough - wheezing - chest tightness - prolonged exhalation - shortness of breath
Chronic asthmatic airway findings (5)
1) thickening of airway wall 2) sub-basement membrane fibrosis 3) increased vascularity 4) increase size of submucosal glands and number of goblet cells 5) hypertrophy of bronchial wall muscle
Asthmatic airway during acute attack
- bronchiole wall inflamed and thickened - tightened smooth muscle
How can exposure to allergens trigger asthma?
allergen activates TH2 cells to activate B cells which recruit mast cells (histamine) to activate eosinophils
Two findings seen in prolonged status asthmaticus
1) curschmann spirals (mucus plugs) 2) charcot-leyden crystals (eosinophil protein galectin-10)
Strongest predisposing factor for asthma
- atopy (heightened response with exposure to inhaled allergens –> dust mites, cockroaches, seasonal pollens)
Difference between asthma and COPD
with asthma: - FEV1 and FEV1/FVC ratio generally return to normal with drug therapy - Symptoms occur/worsen at night and wake up patient
Asthma Flow volume loop pre and post bronchodilator
Flow volume loop with vocal cord dysfunction
usually with tall, thin, young women who are SOB with exertion
First line quick relief asthma medication
Beta 2 agonists
- SABA (albuterol or levalbuterol)
Preferred Step 2 asthma treatment
Low-dose inhaled corticosteroid
- fluticasone
- beclomethasone
- budesonide
leukotriene modifier drugs
Leukotrinene receptor antagonists
- montelukast
- zafirlukast
5-lipoxygenase inhibitor
- Zileuton
Where are leukotrienes released from?
mast cells
