Exam #01 - Asthma (Pathophsyiology) Flashcards
(50 cards)
True or False - Inflammation caused recurrent episodes of asthmatic symptoms is often irreversible?
False, airway obstruction from inflammation is often reversible either spontaneously or with Tx
Define asthma
Asthma is a CHRONIC, INFLAMMATORY disorder of the airways which involves many inflammatory cells, but mostly eosinophils
What actually causes wheezing, breathlessness, chest tightness, and coughing in patients with asthma?
the inflammation
When do recurrent episodes of S/S of asthma mostly occur?
at night or in the early AM
How many people are affected with asthma in the US?
23 million
How many people die annually from asthma?
4,000
Asthma is the most common death in which specific demographic? Why?
AAM 18-25 y/o
They are either under diagnosed, untreated for particular diagnosis, or didn’t know how to use medication properly
How can pharmacists impact patients diagnosed with asthma and the healthcare system (3 things)?
- EDUCATE about disease state and meds
- VERIFY understanding of inhaler technique
- DECREASE COST, DECREASE MORTALITY
True or False - there is a strong genetic component to developing asthma?
True - positive family history is one of the factors involved in childhood onset of asthma
What (3) coexisting conditions are associated with adult onset asthma?
- severe sinusitis
- nasal polyps
- hypersensitivity to NSAIDs and/or ASA (agents that can induce adult onset asthma)
What is the #1 cause of adult onset asthma?
occupational exposure
What (2) factors are associated with childhood onset asthma?
- (+) family history of allergy and/or asthma
2. atopy (genetic susceptibility to produce IgE in response to environmental allergens
What environmental allergens associated with childhood onset asthma cause the body to produce IgE?
- tree, grass, pollen
- dust mites
- pets
List (6) agents/events that trigger asthma?
- Drugs/preservatives
- Environment (cats, cleanliness, dust mites)
- Allergens (pollen, fungus,mold, cockroach feces)
- Respiratory infections (RSV, pneumonia, flu)
- Exercise (mostly in cold, dry air)
- Occupational stimuli
DEARE O
List (5) drugs/preservatives that trigger asthma?
- non-selective B-blockers
- NSAID
- ASA
- sulfites (wines & cheeses)
- benzalkonium chloride
List (4) factors that can exacerbate asthma (but don’t actually induce asthma)?
- GERD
- Rhinitis, sinusitis
- emotions
- premenstrual period
These don’t actually cause asthma
Explain the pathophysiology of asthma?
Environmental risk factors (pollen, mold, dust mites, etc.) cause inflammation of the airways. This leads to airflow obstruction and asthma symptoms (SOB, coughing, wheezing).
Inflammation can also lead to airway hyper-responsiveness in which the airway is “ready to close at any moment” which can be brought on by precipitants like grass, pollen, etc.
Upon release of IgE, several cellular mechanisms are involved in promoting inflammation and bronchospasm. List (3) inflammatory mediator cells involved in asthma?
- Eosinophils
- Neutrophils
- Macrophages
Which inflammatory mediator cell is responsible for releasing histamine, leukotrienes, and PG’s? What effect do these inflammatory mediator cells have?
Mast cells
Release of these inflammatory mediators causes BRONCHOCONSTRICTION
Explain TH-1 and TH-2 cell imbalance in a newborn and how that affects their risk for developing asthma?
It is hypothesized that allergic asthmatic inflammation results from a TH-2 mediated mechanism and, since the T-cell population of a newborn is skewed toward TH-2 phenotype, newborns are at an increased risk to developing asthma.
TH-1 cells produce factors important for cellular defense while TH-2 cells produce cytokines that mediate allergic inflammation. TH-1 cells produce cytokines that inhibit the production of TH-2 cytokines.
What is the basic premise of the hygiene hypothesis? What factors can enhance TH-1 mediated response and shift the balance of TH production to TH-1?
Parents keep their newborn away from all germs, bacteria, and environmental stimuli and therefore their immune system develops with a susceptibility towards asthma. Keeping a newborn sheltered never challenges their immune system and TH-1 cells are not produced. Because newborn T-cell population is skewed toward TH-2 phenotype, the sheltering perpetuates an imbalanced immune system and an increased risk for developing asthma
Factors that will enhance TH-1 mediate response are:
- infection (TB, measles, Hep A)
- exposure to daycare in 1st 6 months of life
- increase exposure to infections from older siblings
What would impede the restoration of the balance between TH-1 and TH-2 cells (5 factors)?
- frequent use of antibiotics
- western lifestyle
- urban environment
- diet
- sensitization to house-dust mites and cockroaches
Give the general timeframes for immediate allergic response (IAR), late asthmatic response (LAR), and chronic asthma?
IAR - minutes
LAR - hours (6-12)
chronic - days
How does the forced expiratory volume 1 second (FEV1) change during the asthmatic response (IAR, LAR, chronic)
Within minutes (IAR) there is a large decline in FEV1, but recovers to about normal and patient feels better. During LAR there is a more gradual decline in FEV1 and then recovery. During chronic there is an up and down FEV1
