Asthma/pumonology/class notes
Terms
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- Bronchial Hyperactivity
-
A pathologic
increase in the bronchconstrictor
response to antigens and irritants caused by
Bronchial inflammation. - IgE-mediated disease
- Disease caused by excessive or misdirected immune response mediated by IgE antibodies
- Mast cell degranulation
-
Exocytosis of granules from mast cells with release of mediators of inflammation and
bronchconstriction - Normal bronchial smooth muscle is controled by what?
- Vagal Innervation
- What happens in patients who are treated with B adrenergic blocking drugs (ie: propranolol)?
- They have increased adrenergic activity, so it manifests as wheezing
- Allergens can trigger asthma, can antihistimines treat it?
- no
- What role do leukotrienes play in the development of asthma?
- Leukotrienes are primary bronchoconstrictors
- What is LTD4?
-
same as histamine but
1000x as potent - second line agents for treatment of asthma that inhibit the synthesis or action of the LTs are known as what?
- leukotriene modulators (LTMs)
- what is the primary reversible component of COPD?
-
Cholinergic activity or sensitivity is often increased in
asthmatics and this increases cholinergic tone of the bronchial smooth
muscle - The inflammatory component of COPD is the same as asthma. T/F
-
F / The
inflammatory component of COPD is different from that of Asthma. COPD manifest an increased production of Neutrophils; Asthma manifest as an increased production of eiosionphils. - what is COPD
- A disease state characterized by airflow limitation that is not fully reversible
- What is the primary cause of COPD
- Smoking
- What are the main symptoms of COPD
-
Chronic obstruction
Emphysema
Mucus plugging -
What events lead to small
airway pathology and increased mucous secretion characteristic of COPD? -
macrophage activation, resulting from exposure to noxious substances, releases
neutrophil chemotactic factors, including interleukin-8 and LTB4. Also
proteases are released that destroy connective tissues in the lung parenchyma, and
oxidants capable of direct tissue damage are produced. - What is the role of proteases in COPD?
-
Proteases destroy connective tissue in the
lungs and produce oxygen radicals that
destroy tissue - What limits airflow in COPD?
- Mucus secretion, fibrosis, and smooth Mucus secretion, severely limits airflow.
- What activates tissue macrophages?
- Noxious substances(esp esp cigarette smoke, occupational dust, chemical inhalants)activate tissue macrophages
- What is asthma?
-
Asthma is a chronic disorder of the airways that causes recurrent and
distressing episodes of wheezing, breathlessness, chest tightness, and
nighttime or early morning coughing. -
Asthma is considered to be a reversible disease; indeed, many asthma
patients experience remission during adolescence and adulthood. T/F - T
-
patients with moderate to
severe asthma experience a decline in lung function each year,
indicating that they may have a progressive form of the disease. T/F -
F / patients with mild to
moderate asthma experience a decline in lung function each year,
indicating that they may have a progressive form of the disease. - Is asthma a progressive disease?
-
Usually not a progressive disease
A sizable minority (about 25%) of asthmatic children
may experience a 1% to 2% decline in predicted lung function per year, even with treatment. - What are the characteristics of asthma
-
airway inflammation
acute reversible bronchoconstriction - what is a late phase response?
- reoccurrence of clinical symptoms 4 - 12 hours after antigen exposure mediated by the basophil, histamine, releasing factors (HRF), eosinophils, and platelet activating factors
- What are the mediators involved in Asthma?
- leukotrienes, (LTC4 and LTD4) , cytokines and enzymes which when released lead to chronic inflammation
- What are the goals in asthma therapy?
-
1. Reverse Acute episodes by relaxing bronchial smooth muscle
2. Reduce bronchial inflammation by mediating the inflammation response
3. Prevent reoccurences and manage exacerbations
4. Reduce morbidity and mortality - What is the recommended approach to therapy
-
avoid allergens
use of anti inflammatories
use of bronchodilators - What is immediated hypersensitivity
- the result of reexposure to an antigen capable of eliciting an IgE response in a susceptible individual producing a clinical reaction (flushing, urticaria, etc) within seconds to minutes as a result of degranulation of mast cells/basophils
- Define allergy
- changed reactivity of the host when meeting an agent on a second or subsequent occasion
- Allergy is considerded type II hypersensitivity T/F
- F / Allergy is type I hypersensitivity
- what are some symptoms of asthma?
- coughing, chest tightness, wheezing, and difficulty breathing
- The inflammation of asthma is not present when a person is asymptomatic T/ F
- F / the inflammation of asthma can be present when a person is asymptomatic
- Define Epidemiology
- The study of the distribution and determinates of diseases and injuries in human populations
- what triggers asthma attacks
- allergens
- What is the most prevalent chronic disease and the number one reason for school absences?
- Asthma
- What race REPORTS the highest rate of asthma
- blacks
- what race actually HAS more asthma?
- Whites
- Define atopy
- a genetic factor characterized by the production of circulating IgE in response to common environmental allergens.
- Will IgE in the blood predict the development of asthma
- Yes
- A parent with asthma will not necessisarily pass on asthma to his/her children
- F / A person with asthma is 3-6 times more likely to develop asthma than someone who does not have a parent with asthma
- Type 1 sensitivity
- Known as immediate or anaphylactic hypersensitivity
- list the reactions of Type I hypersensitivity
-
Urticaria and eczema
conjunctivitis,
rhinorrhea, rhinitis
asthma, gastroenteritis - Poison Ivy is an example of what type hypersensitivity reaction?
- Type IV
- Name some common indoor allergens
- dust mites, cockroaches, fungi (dark, moist, hot), furry animals (pets and pests)
- What are some common outdoor allergens
- Trees, grasses, weeds, pollens, fungi (molds and yeasts)
- What does a person experience when going through an asthma attack?
- Worsening chest tightness, wheezing, coughing, waking at night, and/or shortness of breath
- What is PEF
-
Peak Expiratory Flow rate:
a way to measure lung function - measured with a peak expiratory flow meter - A peak flow < 60% of your personal best is indicative of?
- an emergency. take rescue medication, call physician or go to emergency room
- peak flow < 80% ?
- take medication and continue to monitor peak flow rate
- what are some signs of an onset of an attack?
-
itchy watery glassy eyes,
itchy, sore throat
sneezing,
congestion
restlessness
runny nose
dark circles under eyes