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Supporting Life > Hypersensitivity and Asthma > Flashcards

Hypersensitivity and Asthma Flashcards

1
Q

Type I

A

Immediate. Anaphylaxis, allergy and atopy

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2
Q

Type II

A

Antibody mediated. Complement and recruitment

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3
Q

Type III

A

Immune complexes - pathology determined by which tissues they are deposited in
Ab-Ag interaction but soluble complexes not cleared
Complement, neutrophils and macrophages

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4
Q

Type IV

A

Cell mediated (delayed response: 24-48 hours)
CD4 ->Th1, 2 and 17 activated -> cytokines
CD8 response

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5
Q

Which type of asthma responds well to ICS?

A

Allergic asthma

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6
Q

Which type of asthma is eosinophilic?

A

Allergic asthma

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7
Q

Which cells are contained in non-allergic asthma sputum?

A

Neutrophils/Eosinophils/neither

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8
Q

Does non-allergic asthma respond well to ICS?

A

Less so than allergic

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9
Q

Diagnosis of asthma:

A

Skin prick wheal > 3mm
IgE > 100 IU/ml
Tryptase levels (transient over 24-48 hours)
Radio-allergo sorbent test; BAT; MAT

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10
Q

Leukotrienes from which inflammatory cell cause vasodilation, bronchoconstriction and inflammation?

A

Basophil

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11
Q

Which interleukin causes eosinophil degranulation?

A

IL-5

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12
Q

Which interleukin causes mucus production?

A

IL-13

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13
Q

Degranulation of which inflammatory cell causes bronchoconstriction and inflammation?

A

Eosinophil

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14
Q

What are the airway symptoms of asthma?

A

Wheezing, SOB, rhinitis, sneezing, runny nose

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15
Q

What are the eye symptoms of asthma?

A

Conjunctivitis

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16
Q

What are the skin symptoms of asthma?

A

Atopic dermatitis

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17
Q

What are the gut symptoms of asthma?

A

Food allergy

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18
Q

Which type of asthma tends to present later and to which demographic?

A

Non-allergic, women

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19
Q

What are the symptoms of long-standing asthma?

A

Fixed airflow limitation and airway remodelling

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20
Q

What makes up inflammatory infiltrate?

A

Recruitment, Th2 cells, mast cells and eosinophils

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21
Q

Histology of asthma:

A

Leaky epithelium, reticular BM thickening, airway SM thickening, submucosal gland hypertrophy

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22
Q

Key features of asthma!

A

Irreversible airway narrowing, constant bronchoconstriction to random stimuli, mucosal inflammation and airway remodelling

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23
Q

Which type II hypersensitivity condition is characterised by Abs against the TSH receptor?

A

Grave’s disease

24
Q

Which type II hypersensitivity condition is characterised by Abs against the Ach receptor?

A

Myasthenia gravis

25
Which type is late-onset asthma?
Type IV
26
Which type is early onset asthma?
Type I
27
What does reduction in FEV1 mean?
Lower volume of air can be expelled in the first second
28
If an asthma patient is using their accessory muscles what is their status?
Sever exacerbation
29
What is the immediate treatment for an acute asthma exacerbation?
SABA: 4-10 puffs pMDI + spacer (every 20 mins for an hour) Prednisolone: 1 mg/kg adults; 1-2 mg/kg children
30
What are the target O2 sats for an acute asthma exacerbation?
90-95%
31
What is the urgent treatment for a severe acute asthma exacerbation? (6 drugs)
``` SABA (nebuliser) Ipratropium bromide O2 Systemic corticosteroid IV Magnesium High dose ICS ```
32
What are the features of a life-threatening asthma exacerbation?
Drowsy, confused or silent chest
33
Clinical features of a mild/moderate asthma exacerbation:
Raised RR PR: 100-120 bpm O2: 90-95% PEF > 50% predicted/ best
34
Clinical features of a severe asthma exacerbation:
RR > 30 PR > 120 bpm O2 < 90% PEF lower than/equal to 50% predicted/best
35
Discharge from acute exacerbation criteria:
SABA not needed, PEF > 60-80% predicted/best, O2 > 94% on room air + resources at home
36
Stage 1 treatment =
SABA (< twice a month with no night waking/exacerbations)
37
Stage 2 treatment =
Low does ICS and SABA as needed
38
Stage 3 treatment =
Low dose ICS and LABA
39
Stage 4 treatment =
Medium-high ICS and LABA
40
Stage 5 treatment =
Refer for additional treatment of monoclonal Abs
41
Formaterol, salmeterol and volanterol are all examples of what?
LABA
42
SABA and LABAs are examples of?
Selective beta-2 adrenoreceptor agonists (bronchodilators)
43
Name short and long acting anticholinergic/muscarinic receptor antagonists: (also bronchodilators in addition to -BAs)
Ipratropium (short) | Tiotropium , umeclodinium (long)
44
What added effect does Tiotropium have over other bronchodilators?
Attenuates IL-13 induced goblet cell hyperplasia and reduces mucus secretion
45
What is the only licensed once daily inhaler drug combination?
Futicasone furoate and vilanterol
46
What do ICSs suppress?
Th2 'type 2' airway inflammation and eosinophilia
47
Which ICS has a long action?
Futicasone Furoate (FF)
48
Which treatment is used for AERD asthma?
LTRA - Montelukast (once daily, oral)
49
What are the side effects of prednisolone?
Obesity, diabetes, cataracts, reflux, glaucoma, osteoporosis, skin disease, psychological conditions
50
Which monoclonal antibody drugs target IL-5?
Mepolizumab, Reslizumab and Benralizumab
51
Which monoclonal antibody drug targets IgE?
Omalizumab
52
What action to biologics against IgE and IL-5 share?
Stop the activation of eosinophils
53
What is the most common cause of exacerbations? | Can be normalised by omalizumab
Viral infection
54
Anti - IL-4R biologic?
Dupilumab (stops Th2 activation of B cells)
55
Anti - TSLP biologic?
Tezepelumab (reduces IL-13,5 release)
56
CRTH2 antagonist biologic?
Fevipiprant (reduces IL-13,5 release)

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