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Asthma/pumonology/class notes


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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
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?
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
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
What are the main symptoms of COPD
Chronic obstruction
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
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
What is the most prevalent chronic disease and the number one reason for school absences?
What race REPORTS the highest rate of asthma
what race actually HAS more asthma?
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
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
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
runny nose
dark circles under eyes

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