Week 210 - Asthma Flashcards by Tom Lawson

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.

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Week 210 - Asthma: What is the pathophysiology behind asthma?

Bronchial hyperreactivity, (in response to allergen) producing bronchial spasm.
Bronchial inflammation (eosinophilic)

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Week 210 - Asthma: What are the symptoms of asthma?

Wheeze
Breathlessness
Cough
Chest tightness

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Week 210 - Asthma: What are the signs of a severe asthma attack?

Tachycardia.
Hyperexpanded chest.
Severe dyspnoea with wheezing.

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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

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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.

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Week 210 - Asthma: Asthma which is responsive to specific allergens is which type?

• Extrinsic.

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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

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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.

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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.

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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%

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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.)

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Week 210 - Asthma: What is the primary prophylaxis of asthma?

Breastfeeding may be beneficial.

* Avoid smoking during pregnancy.

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Week 210 - Asthma: What is the secondary prophylaxis of asthma?

Aeroallergen avoidance.

* Weight loss, in obese patients, to improve control.

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Week 210 - Asthma: What are the two main medicine groups for pharmacological management of asthma?

Bronchodilators

* Anti-inflammatories.

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Week 210 - Asthma: Give the types of bronchodilators and examples for each.

SABAs - Short-acting Beta2-agonists - Salbutamol, ventolin.
LABAs - Long-acting Beta2-agonists
Aminophylline
Magnesium (Severe acute asthma)

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Week 210 - Asthma: Give examples of anti-inflammatories used in the treatment of asthma.

Inhaled corticosteroids.

* Leukotriene antagonists.

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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.

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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.

* LABA

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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.
• LABA
• If needed;
- Theophylline
- Leukotriene antagonist
- Oral corticosteroid

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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.

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Week 210 - Asthma: What is atopy?

• A genetic predisposition towards the development of immediate hypersensitivity towards common environmental allergens.

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Week 210 - Asthma: What are the environmental risk factors for developing/antagonising asthma?

Smoking
Occupational
Polution

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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 * IL2 * IL10 * TNF Alpha/beta

Week 210 - Asthma: Th1 cells are pro-atopic, which cytokines do they produce?

* IL3,4,5,6,13 | * GM-CSF

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. * Cytokines

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?

IL-4, IL-13

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. - Degranulation. - 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. * Hypoxia * 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. * GORD * 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 * Asthma * 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?

* Asthma | * 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?

• Candida

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?

* Osteoporosis. * 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. * Salmeterol * Formoterol

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 * Tachycardia * Convulsions * Coma

Week 210 - Asthma: Name 3 conditions and 2 drugs that increase the half-life of theophylline.

* Hepatic cirrhosis. * CHF * Acute pulmonary oedema. * Erythromycin * Fluconazole