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Advanced Pharmocology > Week 3 Asthma > Flashcards

Week 3 Asthma Flashcards

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1
Q

What is asthma?

A

Asthma is a chronic inflammatory disorder of the airways characterized by recurrent episodes of coughing, wheezing, breathlessness, and chest tightness.

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2
Q

What cells and cellular elements are involved in asthma?

A
  • Mast cells
  • Eosinophils
  • Neutrophils
  • T lymphocytes
  • Macrophages
  • Epithelial cells
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3
Q

What is the male-to-female ratio for asthma in childhood?

A

2:1 in childhood; this reverses in adulthood.

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4
Q

What percentage of the population in the United States is affected by asthma?

A

Approximately 8%.

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5
Q

What are the common predisposing factors for asthma?

A
  • Genetics
  • Atopy
  • Perinatal factors
  • Sex
  • Obesity
  • Maternal factors
  • Environmental factors
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6
Q

What is atopy?

A

Genetic predisposition to produce immunoglobulin E (IgE) antibodies on allergen exposure.

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7
Q

What environmental factors increase the risk of asthma?

A
  • Respiratory infections
  • Pollution
  • Smoking
  • Occupational exposure
  • Allergens
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8
Q

What are common allergens associated with asthma?

A
  • Seasonal pollens (trees, grasses, weeds)
  • House dust mites
  • Cat and dog dander
  • Cockroaches
  • Molds
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9
Q

What are the classifications of asthma based on severity?

A
  • Mild
  • Moderate
  • Severe
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10
Q

What are the clinical phenotypes of asthma?

A
  • Allergic (atopic) or extrinsic asthma
  • Nonallergic eosinophilic asthma
  • Nonallergic (intrinsic) asthma
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11
Q

What characterizes allergic (atopic) asthma?

A

IgE-mediated sensitization to environmental allergens, eosinophilia, and steroid responsiveness.

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12
Q

What are the signs of an acute asthma attack?

A
  • Cough
  • Wheezing
  • Anxiety
  • Dyspnea
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13
Q

What is the role of spirometry in asthma diagnosis?

A

Measures FEV1 and FVC to assess airflow limitation and reversibility.

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14
Q

What does a decrease in FEV1 and FEV1/FVC ratio < 0.70 suggest?

A

Airway obstruction.

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15
Q

What is the significance of exhaled nitric oxide (FeNO) in asthma?

A

FeNO > 50 parts per billion indicates eosinophilic airway inflammation.

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16
Q

What are the symptoms of asthma?

A
  • Recurrent wheezing
  • Dyspnea
  • Cough (dry or productive)
  • Symptoms worse at night and early morning
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17
Q

What tests confirm the diagnosis of asthma?

A
  • Spirometry
  • Peak flow measurement
  • Exclusion of other diagnoses
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18
Q

What does bronchoprovocation testing assess?

A

Airway hyperresponsiveness by triggering bronchoconstriction.

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19
Q

What is the potential impact of environmental factors on nonatopic asthma?

A

Involves Th1 and Th17 cell responses leading to neutrophilic inflammation.

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20
Q

True or False: Asthma is always associated with eosinophilic inflammation.

A

False.

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21
Q

What are the key components of asthma pathophysiology?

A
  • Inflammation
  • Airway obstruction
  • Airway hyperresponsiveness
  • Airway remodeling
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22
Q

What are the behavioral and psychological triggers for asthma?

A
  • Exercise
  • Hyperventilation
  • Stress
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23
Q

What is the role of maternal factors in asthma risk?

A

Decreased risk with increasing maternal age at delivery and breastfeeding; increased risk with poorly controlled maternal asthma and prenatal exposure to smoking.

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24
Q

What is the significance of identifying asthma triggers?

A

Helps in managing and preventing asthma exacerbations.

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25
Fill in the blank: Asthma is classified into _____ based on its severity.
[mild, moderate, severe]
26
What physical examination findings may suggest asthma?
* Wheezing * Tachypnea * Tachycardia * Prolonged expiratory phase
27
What is an indirect measure of baseline IL-13 activity used for in asthma?
To identify patients with type 2 severe asthma ## Footnote IL-13 generates eosinophil chemoattractants.
28
What is the purpose of the sweat chloride test in children?
To rule out cystic fibrosis in children with persistent respiratory symptoms ## Footnote A low threshold is recommended due to lifelong implications of the disease.
29
When should arterial blood gas be obtained in asthma exacerbations?
When oxygen saturation is < 94%, no bronchodilator response, or mental status changes.
30
What are the initial findings in respiratory failure during asthma exacerbation?
Hypoxia, hypercarbia, ↓ pH (respiratory acidosis).
31
What classification terms does the NAEPP use for asthma severity?
Intermittent, Mild persistent, Moderate persistent, Severe.
32
What is the symptom frequency for intermittent asthma according to NAEPP?
Symptoms ≤ 2 days/week.
33
What is the expected lung function (FEV1) in severe persistent asthma?
FEV1 < 60%.
34
What are the goals of asthma management?
Control symptoms, maintain normal activity levels, minimize risk of exacerbations, persistent airflow limitation, side effects, and death.
35
What are some recommended nonpharmacologic management strategies for asthma?
* Patient education * Home monitoring * Identify and minimize environmental triggers * Discuss asthma action plan * Smoking cessation * Vaccinations (annual influenza, pneumococcal, COVID-19).
36
What types of bronchodilators are used in asthma treatment?
* Short-acting beta-agonists (SABAs) * Long-acting beta-agonists (LABAs) * Long-acting muscarinic antagonists (LAMAs).
37
What is the role of inhaled corticosteroids (ICS) in asthma management?
ICSs are recommended for almost all patients with asthma.
38
What is a contraindication for prescribing LABA monotherapy?
LABA monotherapy should not be prescribed.
39
Fill in the blank: The preferred initial treatment for asthma according to GINA step 1 is _______.
[low-dose ICS with rapid-onset LABA (e.g., formoterol) as needed].
40
What medications are included in the combination therapy for asthma?
* Bronchodilators plus ICS * LTRAs * Biologics (e.g., omalizumab, reslizumab, mepolizumab, dupilumab).
41
What is the preferred medication for step 2 in asthma management according to GINA?
Low-dose ICS/formoterol as needed.
42
What should be monitored during follow-up assessments for asthma?
* Symptom control * Risk of exacerbations * Lung function. ## Footnote Tools such as ACQ, ACT, GINA symptom control tool can assist.
43
What is indicated for hospitalization in asthma exacerbations?
Pretreatment FEV1 or PEF < 25% predicted/personal best.
44
What initial treatment options are available for mild to moderate asthma exacerbations?
* SABAs * Ipratropium (if needed) * O2 as needed * Oral corticosteroids.
45
What should be considered before discharging a patient after an asthma exacerbation?
* Arrange follow-up within 2–7 days * Review medication list * Ensure patient understanding of medication therapies.
46
What is a key feature of type 2 inflammation in severe asthma?
Characterized by production of IL-4, IL-5, and IL-13 by the adaptive immune system.
47
What are signs that warrant reassessment in asthma management?
* Vitals * Clinical features * PEF.
48
What is the role of high-flow oxygen in acute asthma management?
Maintain oxygen saturation at 93%–95%.
49
What initial therapy is used for severe asthma exacerbations?
* SABA * Ipratropium * O2 as needed * Oral or IV corticosteroids.
50
What are the indications for IV magnesium in asthma treatment?
Not recommended for routine use but may help in patients not responsive to initial therapy.
51
In the context of asthma exacerbations, what does PEF stand for?
Peak expiratory flow.
52
What is the expected FEV1 or PEF post-treatment to consider discharge?
Posttreatment PEF > 60%.
53
What is a common cause of stridor rather than wheezing in upper airway obstruction?
Tumor or laryngeal edema ## Footnote Flow-volume loop shows a limitation in flow in both inspiratory and expiratory curves. Bronchoscopy confirms diagnosis.
54
What imaging might show unilateral hyperinflation or infiltrate in foreign-body aspiration?
Chest X-ray ## Footnote Bronchoscopy is diagnostic and therapeutic for foreign body retrieval.
55
What additional findings accompany wheezing in left ventricular failure?
Crackles ## Footnote History, physical examination, chest X-ray, echocardiogram, and ECG help distinguish congestive heart failure.
56
What symptoms are associated with vocal cord dysfunction?
Wheezing, cough, and dyspnea ## Footnote Spirometry shows flattened inspiratory flow loop suggestive of variable extrathoracic obstruction. Laryngoscopy is the gold standard for diagnosis.
57
What condition may present with cough and wheezing and is refractory to usual asthma treatment?
Eosinophilic granulomatosis with polyangiitis ## Footnote It has peripheral manifestations of vasculitis.
58
What are common symptoms of chronic obstructive pulmonary disease (COPD)?
Dyspnea, cough, and wheezing ## Footnote COPD has a strong association with smoking history.
59
What does a pulmonary function test show in COPD?
Obstructive pattern without significant reversibility ## Footnote Emphysema, a form of COPD, has reduced diffusing capacity of the lung for carbon monoxide (DLCO).
60
Fill in the blank: Bronchoscopy is diagnostic and therapeutic for _______.
foreign body retrieval
61
True or False: Eosinophilic granulomatosis with polyangiitis typically responds well to standard asthma treatments.
False ## Footnote This condition is refractory to usual asthma treatment.

Advanced Pharmocology (42 decks)

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