CVR asthma and respiratory immunology

Question 1

cardinal features of asthma (4)

Answer 1

1. wheeze
2. atopy
3. reversible airflow obstruction
4. airway inflammation

Question 2

what do you test for to confirm asthma diagnosis? (3)

Answer 2

1. atopy
2. reversible airflow obstruction
3. airway inflammation -> eosinophilia and type 2 - lymphocytes

Question 3

way to check for reversible lung obstruction

Answer 3

lung function tests

e.g. spirometry (obtain flow volume loop from this)

Question 4

what does allergic reaction cause in the airway? (2)

Answer 4

1. airway remodelling

2. inflammation

Question 5

which layers are affected in the airway during allergic asthma?

Answer 5

all of them

(bronchial epithelium, matrix, smooth muscle)

Question 6

why do only some people who have allergies have asthma?

Answer 6

genetic susceptibility

Question 7

what genes are more prevalent in asthma?

Answer 7

IL-33 gene

GSDMB

Question 8

What is type 2 immunity?

Answer 8

the adaptive response to allergen exposure in atopic individuals`

Question 9

what are the antigen-presenting cells in the lung?

Answer 9

dendritic cells

Question 10

what do dendritic cells carry antigens via in the type 2 immune response?

Answer 10

MHC class II
-> go to lymph nodes, causes TH0 cells to turn in to TH2 cells

Question 11

what ILs are secreted by Th2 cells in the type 2 immune allergic response?

Answer 11

4,5, 13

Question 12

what does IL-5 promote?

Answer 12

eosinophil recruitment and prolonged survival

Question 13

what does IL-4 promote?

Answer 13

b cell secretion of IgE

Question 14

what does IL-13 promote?

Answer 14

mucous secretion

Question 15

what does activated IgE bind?

Answer 15

mast cells

Question 16

what do mast cells release when they degranulate?

Answer 16

GFs, cytokines, chemokines

-> histamines, nicotinoids, type II mediators

Question 17

diagnostic test for allergic sensitisation

Answer 17

1. bloods for specific IgE antibodies

2. skin prick test (wheel and flare if allergic)

Question 18

what can be exhaled in a breath test, when someone in asthmatic?

Answer 18

nitric oxide

-> elevated = supportive of diagnosis

Question 19

what can FeNO have a role in aiding?

Answer 19

1. asthma diagnosis
2. predicting steroid responsiveness
3. assessing adherence to inhaled corticosteroids (should be low if compliant)

Question 20

NICE asthma diagnosis guidelines

Answer 20

clinical: history and examination, assess/confirm wheeze when acutely unwell

Spirometry: FEV1/FVC ratio: <0.7
Reversibility of airway obstruction: bronchodilator reversibility >=12%
Exhaled nitric oxide > 35ppb (kids), >40 (adults)

Question 21

aim of asthma treatments (2) and example of how to manage asthma (1)

Answer 21

1. reduce airway eosinophilic inflammation
2. acute symptomatic relief
3. severe asthma = steroid-sparing therapies

Question 22

how to reduce airway eosinophilic inflammation

Answer 22

1. inhaled corticosteroids

2. leukotriene receptor antagonists

Question 23

how to provide acute symptomatic relief (2)

Answer 23

1. beta-2agonists

2. anticholinergic therapies

Question 24

examples of steroid-sparing therapies

Answer 24

1. biologic targeted to IgE (anti-IgE AB)

2. Biologic targeted to airway eosinophils (anti-IL5-AB, anti-IL5receptor- AB)

Question 25

how to corticosteroids reduce eosinophil count?

Answer 25

promoting apoptosis

Question 26

what do corticosteroids do to type 2 mediators?

Answer 26

reduce them

Question 27

what do corticosteroids do to mast cells in asthma?

Answer 27

reduce their number

Question 28

what is the most important aspect of asthma management?

Answer 28

adherence to inhaled corticosteroids

Question 29

facets of asthma management (3)

Answer 29

1. optimal device technique 2. clear asthma management plan 3. adherence to inhaled corticosteroids

Question 30

what must patients, even with mild asthma, always be prescribed?

Answer 30

a preventor | -> never just give as-required bronchodilators, always start with anti-inflammatory therapy

Question 31

what do you do if patient doesn't response to inhaled corticosteroids and/or LTRA?

Answer 31

refer to a specialist | -> same for children

Question 32

how do beta-2 agonists help with asthma?

Answer 32

stimulate the beta-2 receptors in the airway, found on muscle: allows muscle to relax.

Question 33

what change in environment can cause an asthma attack?

Answer 33

- suddenly cold | - allergen presence

Question 34

what is reduced in patient with asthma caused by infection?

Answer 34

reduced anti-viral response | - IFN alpha, beta and lamda(?) reduced

Question 35

name of anti-IgE AB used?

Answer 35

omalizumab

Question 36

criteria to be given omalizumab?

Answer 36

severe, persistent allergic mediated asthma in patients aged >= 6 years. Require frequent or continuous treatment with oral corticosteroids

Question 37

how is dose of omalizumab decided? (2)

Answer 37

weight and serum IgE

Question 38

how is omalizumab given?

Answer 38

2-4 weekly s/c injection

Question 39

what is mepolizumab?

Answer 39

anti-IL5-antibody

Question 40

who is given mepolizumab?

Answer 40

people with severe eosinophilic asthma | - suitable for adults and kids >=6yrs

Question 41

how does IL-5 work?

Answer 41

regulates growth, recruitment, activation and eosinophil survival