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Flashcards in Week 210 - Asthma Deck (58):
1

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.

2

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

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

3

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

• Wheeze
• Breathlessness
• Cough
• Chest tightness

4

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

• Tachycardia.
• Hyperexpanded chest.
• Severe dyspnoea with wheezing.

5

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

6

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.

7

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

• Extrinsic.

8

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

9

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.

10

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.

11

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%

12

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.)

13

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

• Breastfeeding may be beneficial.
• Avoid smoking during pregnancy.

14

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

• Aeroallergen avoidance.
• Weight loss, in obese patients, to improve control.

15

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

• Bronchodilators
• Anti-inflammatories.

16

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)

17

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

• Inhaled corticosteroids.
• Leukotriene antagonists.

18

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.

19

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

20

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

21

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.

22

Week 210 - Asthma: What is atopy?

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

23

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

• Smoking
• Occupational
• Polution

24

Week 210 - Asthma: CD4+ are which kind of cells?

• T-helper cells.

25

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

26

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

• IFN Gamma
• IL2
• IL10
• TNF Alpha/beta

27

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

• IL3,4,5,6,13
• GM-CSF

28

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

29

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

30

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.

31

Week 210 - Asthma: IgE production is stimulated by which cytokines?

IL-4, IL-13

32

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.

33

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.

34

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)

35

Week 210 - Asthma: What are the two actions of salbutamol?

• Beta-2 agonist, promotes smooth muscle relaxation.
• Stabilises mast cells.

36

Week 210 - Asthma: Omalizumab?

• Anti-IgE antibody.

37

Week 210 - Asthma: What is Mepoluzimab?

• Mono-clonal antibody for IL-5.
• Helps to reduce asthma symptoms by reducing eosinophil recruitment.

38

Week 210 - Asthma: How can aspirin aggravate asthma?

• Inhibits cox-2, which has a role in the production of broncho-dilatory prostaglandins.

39

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.

40

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.

41

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.

42

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

43

Week 210 - Asthma: A schoolage/teenage child presents to clinic with chronic cough +/- wheeze. What is the most likely diagnosis?

• Asthma
• Recurrent viral hepatitis

44

Week 210 - Asthma: What asthma devices should be used in a preschool child?

• Metered-dose inhaler and spacer.

45

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.

46

Week 210 - Asthma: What is the main short term symptom of inhaled steroids?

• Candida

47

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.

48

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.

49

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

50

Week 210 - Asthma: Give examples of inhaled corticosteroids and give the colour for the pump of each.

• Beclometasone - Brown
• Fluticasone - Red
• Budesonide - Brown

51

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

52

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.

53

Week 210 - Asthma: What is the symbicort smart regime?

Symbicort (Budesonide and Formoterol) for both prevention and relief.

54

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.

55

Week 210 - Asthma: Give some examples of Leukotriene receptor antagonists. What are the side effects?

• Montelukast, Zafirlukast
• GI disturbances and headache.

56

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

57

Week 210 - Asthma: What are the side-effects of theophylline?

• Nausea and vomitting
• Tachycardia
• Convulsions
• Coma

58

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

• Hepatic cirrhosis.
• CHF
• Acute pulmonary oedema.

• Erythromycin
• Fluconazole