High-Yield Concepts in Bronchial Asthma

Question 1

Reversibility in asthma (spirometry) is demonstrated by

Answer 1

> 12% and 200 mL increase in FEV1:
15 minutes after an inhaled short-acting B2-agonist; or
After a 2 to 4 week trial of oral corticosteroids (prednisone or prednisolone 30-40 mg daily)

Question 2

Physiologic abnormality of asthma

Answer 2

Airway hyperresponsiveness

Question 3

Pathogenesis behind asthma

Answer 3

Imbalance favoring TH2 production over TH1 → increases IL-1, IL-5 → increased eosinophils

Question 4

Putative mediators of asthma

Answer 4

SRS-A (made up of leukotrienes C4, D4, E4)

Question 5

Whorls of shed epithelium in mucus plugs in asthma

Answer 5

Curschmann’s Spirals

Question 6

Crystalloid made up of eosinophil membrane protein seen in both asthma & amoebiasis

Answer 6

Charcot-Leyden Crystals

Question 7

Predominant key cell involved in asthma

Answer 7

None

Question 8

Characteristic feature of asthmatic airways

Answer 8

Eosinophil infiltration

Question 9

Most common allergens that trigger asthma

Answer 9

Dermatophagoides (house dust mites)

Question 10

Most common triggers of acute severe asthma exacerbations

Answer 10

URTI: rhinovirus, respiratory syncytial virus (RSV), coronavirus

Question 11

Mechanism of exercise-induced asthma (EIA)

Answer 11

Hyperventilation

Question 12

EIA is best prevented by regular treatment with

Answer 12

Inhaled corticosteroids (ICS)

Question 13

Confirms airflow limitation with a reduced FEV1, FEV1/FVC ratio, and PEF

Answer 13

Spirometry

Question 14

Confirms diurnal variations in airflow obstruction

Answer 14

Measurements of PEF twice daily

Question 15

Primary action of B2-agonists

Answer 15

Relax smooth-muscle cells of all airways, where they act as functional antagonists

Question 16

Most common side effects of B2-agonists

Answer 16

Muscle tremor and palpitations

Question 17

Most common side effect of anticholinergics

Answer 17

Dry mouth

Question 18

Most common side effects of theophylline

Answer 18

Nausea, vomiting, headaches

Question 19

Most effective controllers for asthma

Answer 19

ICS

Question 20

Indicates the need for regular controller therapy

Answer 20

Use of a reliever medication > 3x a week

Question 21

Most common reason for poor control of asthma

Answer 21

Noncompliance with medications, usually ICS

Question 22

Drugs that are safe for asthma in pregnancy

Answer 22

Short-acting B2-agonists
ICS
Theophylline