When discussing FEV & FVC what are the expected trends for normal lung function, obstructive lung disease, restrictive lung disease (graph)
Normal- FEV = 4, FVC = five; percent = 80
This graph will show quick steep drop
Obstructive-FEV = 1.3, FVC = 3.1; percent =42
The graph shows shallow long expiration
Restrictive-FEV= 2.8, FVC = 3.1; percent = 90
Graph shows steep short expiration
What do you FEV and FVC stand for
FEV forced expiratory volume
FVC forced vital capacity
What is asthma?
A group of symptoms and signs (a syndrome)
Symptoms-wheezing, cough, chest tightness, and SOB especially at night and early in the morning
Chronic episodes of airway symptoms and obstruction
Episodic chest symptoms and air obstruction
Chronic air information with increased eosinophils , lymphocyte and smooth muscle hypertrophy
What is chronic bronchitis
Chronic air mucus hypersecretion
Neutrophils, submucosal gland and goblet cells hypertrophy
Nearly constant productive cough, variable airflow obstruction
What is emphysema
Permanent destruction of alveoli
Fewer larger alveoli, reduce surface area & oxygen transfer to the blood, reduced elastic recoil
Constant airflow obstruction
List the phenotypes of asthma
Early onset allergic asthma
Late onset Eosinophilia
Exercise-induced
Obesity related
Neutrophilic
Explain the main points of early onset allergic asthma
Allergic symptoms
TH2 profile
Corticosteroid responsive
Describe the main points of Eosinophilia
Less allergic
Eosinophilia
Not responsive to corticosteroids
Describe the main points of exercise-induced asthma
TH2 cytokines
mast cell activation
Explain the details of obesity related asthma
Adult onset
Mostly in women
No TH2 marker
Explain the details of neutrophilic asthma
TH17
How many people does asthma affect in the United States
25.7 million people
7 million under the age of 18 years old
How do epidemiologist define people having asthma
By the responses given from an individual when asked have you ever been told by a doctor that you have asthma
Breakdown asthma prevalence in different subgroups in the United States
Blacks > white or Hispanic
Children >adults
Young boys >young girls (0 to 14 years old)
Boys = girls (15 to 17 years old)
Women >men
Define chronic bronchitis
Chronic cough chronic mucus production (productive cough)
In what disease is alveolar destruction
Emphysema
There’s a graph that shows methacholine introduced to those that are hyper responsive (as) and show an increase in histamine production
The faster the response the greater the________?
Sensitivity
Explain the TH2 immune processes in the airways of people with asthma
One allergen enters
Taken up by antigen presenting cells
Antigen presenting cells process antigen present to TH2 cells
TH2 cells make cytokines
Some cytokines are present to this stimulate the epithelial layer, stimulates smooth cells to cause hypertrophy, some recruit and activate eosinophils , some activate B cells
B cells make anybody used in this instance they make IGE-which attached to the outside of mast cells then the next time the allergen is detected the mast cell is triggered to degranulation-releasing histamines, bronchoconstriction-causing an asthma attack
Describe the process of a non-TH2 asthma development
Can be more associated with damage to the epithelial layer or viruses/microbes in the lungs
Binding to microphages
The damps that get released (by the broken cell)
Activated macrophages
Macrophages can activate neutrophil and TH17 cells
List the classifications of occupational
Respiratory sensitization asthma
Acute irritant induced asthma
Recurrent low dose irritant induced asthma
Work aggravated asthma
Chronic obstructive pulmonary disease-end-stage asthma
Give the main points of respiratory sensitization asthma
Adult onset as a result of exposure at work
Immune mechanisms may not be well defined
Latency
List main points of acute irritant induced asthma
Adult onset asthma as a result of high dose exposure to irritants at work
Reactive airway dysfunction syndrome (RADS)
No latency
Describe the main points of recurrent low dose irritant induced asthma
Adult onset asthma as a result of prolonged moderately high exposure to irritants at work
Latency
Describe the main points of work aggravated asthma
Pre-existing asthma with new exposure to triggers at work
Loss of asthma control
Describe the main points of chronic obstructive pulmonary disease-end stage asthma
Impairment resulting after many years of one of The other classifications of occupational asthma, usually without treatment or removal from exposure
What protease degrades the elastic fibers of the alveoli and collagen?
Neutrophil elastase
List and briefly describe the Serpina 1 variants
PiS-make less alpha-1 antitrypsin and so if you have a last of the alpha-1 antitrypsin then you have a lower threshold for a reaction
PiZ- make even less a one antitrypsin and so you have an even more elevated risk
These are affected by smoking because they block protease activity and smoking inhibits anti-protease activity
Name the two branches of acquired immunity that are most relevant to asthma
TH2
TH17