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In chronic inflammatory d/o of the airways which cells play a role?
mast cells, eosinophils, T lymphocytes, and epithelial cells
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Asthma causes interaction between environmental and genetic factors. Name some stimuli that cause bronchospasms:
- allergens
- Infection
- exercise
- inhaled irritants
- NSAIDS
- emotional
- GERD
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What is the main differentiating factor between asthma and COPD?
Asthma is reversible
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Common presentation of asthma?
wheezing, breathlessness, chest tightness
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Asthmatic cough is typically seen during what time of the day?
PM>AM
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2 response mechanisms associated with asthma?
inflammatory->infiltration of the inflammatory cells->relaease of cytokines, IL, and other inflammatory mediators->airway inflammation
bronchospastic->mast cells release histamine, leukotrienes, IL, and prostaglandins
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Info: The distal bronchial tree-> decreased cartilage-> more smooth muscle lining the lumen that is controlled by para/sympathetic stimulation
More parasympathetic controll is located at the lumen which allows for more latitude/space esp. during exercise
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Asthma may present with this only sign which can also be indicative of CHF.
Cough
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Pharmacologic interventions are aimed at what 2 response mechanisms? Give examples for each.
Inflammatory= inhaled steroids
Bronchospastic=sympathetic B Agonists and Anticholinergics
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Asthma Manifestions:
What measures are key indicators of Asthma broncospasm? What other spirometry values that are affected?
decreased FEV1 and FEV1/FVC
- prolonged expiratory effort
- decreased PEF, IRC, FVC
- increased RV
- Hyperinflation
- Breathing is close to functional residual capacity
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Asthma manifestations:
less effective cough, accessory muscle usage, ventilation/perfusion mismatch
Hypoxemia, hypercapnia (increased CO2 in blood): BEWARE: Normal PCO2 initially in severe attack
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What is the main trigger for asthma?
COPD?
sensitizing agent (e.g allergen)
Toxic injury (e.g. smoking)
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Inflammatory cells triggered by an asthma attack?
CD4, lymphocytes and eosinophils
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COPD inflammatory cells that respond during an attack?
CD8, Lymphocytes, and PMNS (polymorphonuclear neutrophils)
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Asthma affects which airways?
Large airways
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COPD affects which airways?
Small airways
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Asthma is reversible.
T or F
T, reversible
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COPD is reversible?
F, irreversible
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All pts with asthma should have a quick relief bronchodilator for use as needed
If quick relief dilators is needed >2 days per week or > 2x month for nighttime awakenings a controller med should be prescribed e.g?
inhaled glucocorticosteroid
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Describe the squence of step up treatment for asthma control
- SABA
- Inhaled Steroid (or Luekotriene receptor antagonist)
- Inhaled steroid+LABA (or inhaled steroid + leukotriene modifier)
- Inhaled steroid +LABA+Luekotriene modifier
- Add anti IgE (omalizumab)
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Inhaled glucocorticoid are the cornerstoned tx for COPD.
T or F
F, it is the cornerstone for asthma tx
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How long do glucocorticoids take to work?
8 weeks
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Review Mild to Severe presentations of asthma
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Name some of the Glucocorticosteroids
- beclomethasone
- budenoside
- fluticasone
- triamcinolone
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Name some of the adverse effects of steroids oral (also high doses of inhaled steroids)
- oral candidiasis
- dysphonia
- growth suppression
- bone fx
- infections
- impaired wound healing
- adrenal axis suppression (atrophy of hippocampus with prolonged use)
- cataracts
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Doubling the dose of an inhaled steroid can have adverse effects. Adding a LABA is the solution for avoiding these effects; if the LABA fails then consider doubling the dose
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