In chronic inflammatory d/o of the airways which cells play a role?
mast cells, eosinophils, T lymphocytes, and epithelial cells
Asthma causes interaction between environmental and genetic factors. Name some stimuli that cause bronchospasms:
- inhaled irritants
What is the main differentiating factor between asthma and COPD?
Asthma is reversible
Common presentation of asthma?
wheezing, breathlessness, chest tightness
Asthmatic cough is typically seen during what time of the day?
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
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
Asthma may present with this only sign which can also be indicative of CHF.
Pharmacologic interventions are aimed at what 2 response mechanisms? Give examples for each.
Inflammatory= inhaled steroids
Bronchospastic=sympathetic B Agonists and Anticholinergics
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
- Breathing is close to functional residual capacity
less effective cough, accessory muscle usage, ventilation/perfusion mismatch
Hypoxemia, hypercapnia (increased CO2 in blood): BEWARE: Normal PCO2 initially in severe attack
What is the main trigger for asthma?
sensitizing agent (e.g allergen)
Toxic injury (e.g. smoking)
Inflammatory cells triggered by an asthma attack?
CD4, lymphocytes and eosinophils
COPD inflammatory cells that respond during an attack?
CD8, Lymphocytes, and PMNS (polymorphonuclear neutrophils)
Asthma affects which airways?
COPD affects which airways?
Asthma is reversible.
T or F
COPD is reversible?
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?
Describe the squence of step up treatment for asthma control
- Inhaled Steroid (or Luekotriene receptor antagonist)
- Inhaled steroid+LABA (or inhaled steroid + leukotriene modifier)
- Inhaled steroid +LABA+Luekotriene modifier
- Add anti IgE (omalizumab)
Inhaled glucocorticoid are the cornerstoned tx for COPD.
T or F
F, it is the cornerstone for asthma tx
How long do glucocorticoids take to work?
Review Mild to Severe presentations of asthma
Name some of the Glucocorticosteroids
Name some of the adverse effects of steroids oral (also high doses of inhaled steroids)
- oral candidiasis
- growth suppression
- bone fx
- impaired wound healing
- adrenal axis suppression (atrophy of hippocampus with prolonged use)
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