Flashcards in Week 210 - Asthma Deck (58):
Week 210 - Asthma: Give a definition of asthma.
• Chronic inflammatory disorder of the airways, characterised by airway hyper-sensitivity, with airway obstruction that is reversible, either with medication or spontaneously.
Week 210 - Asthma: What is the pathophysiology behind asthma?
• Bronchial hyperreactivity, (in response to allergen) producing bronchial spasm.
• Bronchial inflammation (eosinophilic)
Week 210 - Asthma: What are the symptoms of asthma?
• Chest tightness
Week 210 - Asthma: What are the signs of a severe asthma attack?
• Hyperexpanded chest.
• Severe dyspnoea with wheezing.
Week 210 - Asthma: What is the pattern of an obstructive airway disease on a spirometry? (FEV1, FVC, FEV1:FVC, PEFR)
FV1 - Reduced
FVC - Normal
FEV1:FVC - <70%
PEFR - Reduced
Week 210 - Asthma: What are the two main types of asthma, give an example of each.
• Extrinsic - IgE mediated - Atopic, occupational.
• Intrinsic - Non-immune - Infection, cold, exercise, stress, irritants.
Week 210 - Asthma: Asthma which is responsive to specific allergens is which type?
Week 210 - Asthma: What are the four classifications of asthma?
• Stage 1 - Intermittent
• Stage 2 - Mild persistent
• Stage 3 - Moderate persistent
• Stage 4 - Severe persistent
Week 210 - Asthma: Describe intermittent asthma in terms of symptoms, night-time symptoms and PEF:FEV1.
• Symptoms - <1 time/week, asymptomatic between attacks.
• Night-time - ≤2 times/month.
• PEF:FEV1 - ≥80% predicted.
Week 210 - Asthma: Describe mild persistent asthma in terms of symptoms, night-time symptoms and PEF:FEV1.
• Symptoms - ≥1/week but 2 times/month.
• PEF:FEV1 - ≥80% predicted.
Week 210 - Asthma: Describe moderate persistent asthma in terms of symptoms, night-time symptoms and PEF:FEV1.
• Symptoms - Daily, use of B2-agonist daily, attacks effect activity.
• Night-time symptoms - >1/week
• PEF:FEV1 - >60% - <80%
Week 210 - Asthma: Describe severe persistent asthma in terms of symptoms, night-time symptoms and PEF:FEV1.
• Symptoms - Continuous, limited physical activity.
• Night-time symptoms - Frequent
• PEF:FEV1 - <60%
(Only need one of these for the asthma to be classed as severe.)
Week 210 - Asthma: What is the primary prophylaxis of asthma?
• Breastfeeding may be beneficial.
• Avoid smoking during pregnancy.
Week 210 - Asthma: What is the secondary prophylaxis of asthma?
• Aeroallergen avoidance.
• Weight loss, in obese patients, to improve control.
Week 210 - Asthma: What are the two main medicine groups for pharmacological management of asthma?
Week 210 - Asthma: Give the types of bronchodilators and examples for each.
• SABAs - Short-acting Beta2-agonists - Salbutamol, ventolin.
• LABAs - Long-acting Beta2-agonists
• Magnesium (Severe acute asthma)
Week 210 - Asthma: Give examples of anti-inflammatories used in the treatment of asthma.
• Inhaled corticosteroids.
• Leukotriene antagonists.
Week 210 - Asthma: Aside from a B2-agonist inhaler for prn, what medication should be added to those suffering from mild asthma?
• Low-dose inhaled corticosteroid.
Week 210 - Asthma: Aside from a B2-agonist inhaler for prn, what medication should be added to those suffering from moderate asthma?
• Low-medium dose inhaled corticosteroid.
Week 210 - Asthma: Aside from a B2-agonist inhaler for prn, what medication should be added to those suffering from severe asthma?
• High dose inhaled corticosteroid.
• If needed;
- Leukotriene antagonist
- Oral corticosteroid
Week 210 - Asthma: What is the general population of asthma for intrinsic and extrinsic types?
• Intrinsic - Typically occurs in later life.
• Extrinsic - The most common type of asthma in children and young adults.
Week 210 - Asthma: What is atopy?
• A genetic predisposition towards the development of immediate hypersensitivity towards common environmental allergens.
Week 210 - Asthma: What are the environmental risk factors for developing/antagonising asthma?
Week 210 - Asthma: CD4+ are which kind of cells?
• T-helper cells.
Week 210 - Asthma: What is the difference between Th1 and Th2 cells?
• They differ based on the cytokines they produce.
• In terms of asthma;
- Th1 - non-atopic
- Th2 - pro-atopic, pro-asthma
Week 210 - Asthma: Th1 cells are non-atopic, which cytokines do they produce?
• IFN Gamma
• TNF Alpha/beta
Week 210 - Asthma: Th1 cells are pro-atopic, which cytokines do they produce?
Week 210 - Asthma: Th2 cells are part of the hypersensitivity response in atopic-asthma. What are the three pathways they produce and which cytokines mediate each?
• Activation of plasma cells > IgE - IL-13, 1L-4.
• Recruitment of mast cells - IL-4, IL-5.
• Recruitment of Eosinophils - IL-3, IL-6, GM-CSF
Week 210 - Asthma: What are the major products of eosinophils?
• Major basic protein - Epithelial damage, loss of tight junctions.
• Eosinophil cation protein - Epithelial shredding.
• Leukotriene - Smooth muscle contraction.
Week 210 - Asthma: What the sensitivity mediators released by mast cells and what physiological effect do they have? (5)
• Histmine - Bronchoconstriction, microvascular leakage, mucus secretion.
• Prostaglandins - Bronchoconstriction
• Leukotrienes - Bronchoconstriction
• IL4/IL4 - Ig subclass switching in B-cells.
• IL5 - Eosinophilic differentiation.
Week 210 - Asthma: IgE production is stimulated by which cytokines?
Week 210 - Asthma: Aside from eosinophils, plasma cells and mast cells, which other cells play an important role in hypersensitivity? Give a brief description for each. (3)
• Dendritic cells - Found in respiratory epithelium, present antigen on MHCII class complexes to Th2 cells.
• Epithelial cells - secrete inflammatory mediators (TSLP) which recruits dendritic cells.
• Macrophages - Also able to express IgE, and can promote cytokines.
Week 210 - Asthma: What occurs pathologically during the early phase response and late phase response of an asthmatic response?
• Early Phase;
- IgE cross linking on mast cells.
- Bronchodilation within minutes.
• Late phase;
- Influx of basophils, eosinophils, T-cells, lymphocytes, macrophages, dendritic cells.
- Inflammation, further bronchoconstriction, epithelial damage.
Week 210 - Asthma: What mediators are released by mast cells, immediately, minutes and hours in response to an allergen?
• Immediate - Histamine, TNF-alpha, Heparin, Proteases.
• Minutes - Leukotriene, protaglandins.
• Hours - Cytokines (IL-4, IL-13) (leading to eosinophil recruitment)
Week 210 - Asthma: What are the two actions of salbutamol?
• Beta-2 agonist, promotes smooth muscle relaxation.
• Stabilises mast cells.
Week 210 - Asthma: Omalizumab?
• Anti-IgE antibody.
Week 210 - Asthma: What is Mepoluzimab?
• Mono-clonal antibody for IL-5.
• Helps to reduce asthma symptoms by reducing eosinophil recruitment.
Week 210 - Asthma: How can aspirin aggravate asthma?
• Inhibits cox-2, which has a role in the production of broncho-dilatory prostaglandins.
Week 210 - Asthma: What is bronchiolitis?
• Most common LRTI in infancy.
• Viral infection during winter months, most commonly Respiratory Syncytial Virus.
• Necrosis of the ciliated cells.
• Leading to bronchiolar obstruction and hyperinflation.
Week 210 - Asthma: What are the signs and symptoms of bronchiolitis?
• Respiratory distress; tachypnoea, grunting, subcostal+intercostal recession, palpable liver edge, tracheal tug, nasal flaring.
• Widespread fine crepitations.
• Prolonged expiratory phase with wheezing.
• Fever in most.
Week 210 - Asthma: An infant (<1) presents to clinic with a chronic cough +/- wheeze. What is the most likely clinical diagnosis?
• Viral - Bronchioloitis, Recurrent URTI.
• Transient-early wheeze.
Week 210 - Asthma: A preschool child presents to clinic with chronic cough +/- wheeze. What is the most likely diagnosis?
• Transient-early wheeze.
• Recurrent viral URTIs
• Inhaled foreign body
• Passive smoking
Week 210 - Asthma: A schoolage/teenage child presents to clinic with chronic cough +/- wheeze. What is the most likely diagnosis?
• Recurrent viral hepatitis
Week 210 - Asthma: What asthma devices should be used in a preschool child?
• Metered-dose inhaler and spacer.
Week 210 - Asthma: What asthma devices should be used for 6-12 years old?
• Bronchodilator - MDI + spacer, Dry powder, breath accentuated.
• Steroids - MDI + large spacer.
Week 210 - Asthma: What is the main short term symptom of inhaled steroids?
Week 210 - Asthma: Give some examples of B2-agonists and describe their method of action.
• Salbultamol, Terbutaline.
• Increases cAMP resulting in bronchial smooth muscle relaxation.
• Also inhibits release of inflammatory mediators and increases mucus clearance.
Week 210 - Asthma: What is the mechanism of action of corticosteroids in the treatment of asthma?
• Reduces the amount of inflammatory cells and reduces vascular permeability.
Week 210 - Asthma: What are the side effects of prolonged use of systemic corticosteroids?
• Increased susceptibility to infection.
• Tendancy to hyperglycaemia
• Easy bruising
• Weight gain
• Growth retardation
• Mood changes
Week 210 - Asthma: Give examples of inhaled corticosteroids and give the colour for the pump of each.
• Beclometasone - Brown
• Fluticasone - Red
• Budesonide - Brown
Week 210 - Asthma: How to SABAs last longer? Give examples.
• There is a lipid side-chain, which prolongs the action of the Beta-2 receptor.
Week 210 - Asthma: Combination inhalers contain which two types of drug? What is the purpose of giving them combined?
• LABA and a corticosteroid (E.g. Symbicort - Budesonide - formoterol.)
• Guarantees that steroid is taken with LABA.
Week 210 - Asthma: What is the symbicort smart regime?
Symbicort (Budesonide and Formoterol) for both prevention and relief.
Week 210 - Asthma: What is the mechanism of action of leukotriene receptor antagonists?
• Reduces bronchoconstriction.
• Reduces eosinophils and basophils influx.
• Reduces mucus and microvascular leakage.
Week 210 - Asthma: Give some examples of Leukotriene receptor antagonists. What are the side effects?
• Montelukast, Zafirlukast
• GI disturbances and headache.
Week 210 - Asthma: What is the mechanism of action for Xanthines in the treatment of asthma. Give examples.
• Inhibits the action of phosphodiesterase which prevents the conversion of cAMP into AMP, which aids bronchodilation.
• Theophylline, aminophylline
Week 210 - Asthma: What are the side-effects of theophylline?
• Nausea and vomitting