Asthma and Pathophysiology Overview
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Questions and Answers

What role do T helper 2 (Th2) cells play in the process of sensitization?

Th2 cells release interleukins that attract inflammatory cells and stimulate B lymphocytes to produce Immunoglobulin E (IgE).

How does IgE contribute to the allergic response upon re-exposure to an allergen?

IgE binds to receptors on mast cells, priming them for re-exposure when the allergen binds to mast cells.

Identify three types of immune cells that Th2 cells attract during sensitization.

Mast cells, eosinophils, and basophils are attracted to the site of allergen exposure.

What is the significance of interleukin release from Th2 cells?

<p>The release of interleukins promotes the recruitment of inflammatory cells and the differentiation of B lymphocytes.</p> Signup and view all the answers

What happens to mast cells after the initial exposure to an allergen?

<p>Mast cells become 'primed' after IgE attaches to them, ready to react upon subsequent exposures to the same allergen.</p> Signup and view all the answers

What are the hallmark symptoms of asthma?

<p>Wheeze, cough, shortness of breath, and chest tightness.</p> Signup and view all the answers

How many people are currently estimated to have asthma globally?

<p>Approximately 339 million people.</p> Signup and view all the answers

What characterizes allergic asthma?

<p>It is triggered by specific allergens and involves a sensitization process.</p> Signup and view all the answers

What is the primary cause of chronic airway obstruction in asthma?

<p>Chronic inflammation and hyperreactivity of the airways.</p> Signup and view all the answers

Which demographic in the UK shows higher rates of childhood asthma?

<p>More males have childhood asthma.</p> Signup and view all the answers

What role do eosinophils play in asthma?

<p>They infiltrate the airways and are associated with airway inflammation.</p> Signup and view all the answers

What leads to mucus hypersecretion during an asthma episode?

<p>Goblet gland hypertrophy and hyperplasia.</p> Signup and view all the answers

What is the asthma mortality rate comparison between the UK and Europe?

<p>The UK has a 50% higher asthma mortality rate than any European country.</p> Signup and view all the answers

What physiological change occurs in the lungs during expiration for asthma patients?

<p>Intrapleural pressure increases, leading to increased airways resistance.</p> Signup and view all the answers

What is the primary type of asthma associated with allergic reactions?

<p>Extrinsic asthma, or allergic asthma.</p> Signup and view all the answers

Which immune response dominance is linked to extrinsic asthma?

<p>TH2 immunity dominance.</p> Signup and view all the answers

What are common environmental triggers for intrinsic asthma?

<p>Environmental pollutants, chemicals, cigarette smoke, and respiratory infections.</p> Signup and view all the answers

What is a significant characteristic of late-onset asthma?

<p>It frequently develops in adults and is more common in females.</p> Signup and view all the answers

What types of inflammatory cells are typically found in the sputum of patients with allergic asthma?

<p>Eosinophils.</p> Signup and view all the answers

How can exercise impact asthma management?

<p>Exercise can induce asthma symptoms, indicating poorly controlled asthma.</p> Signup and view all the answers

What family medical history is often associated with allergic asthma?

<p>A family history of rhinitis, eczema, and hay fever.</p> Signup and view all the answers

What are the factors contributing to airway narrowing during sleep?

<p>Diurnal factors, relative narrowing of the airways, and reduced mucociliary clearance.</p> Signup and view all the answers

How does airway remodelling affect cough reflex?

<p>It leads to denudation of cilia and respiratory epithelium, causing a buildup of mucus that stimulates cough receptors.</p> Signup and view all the answers

What physiological changes occur in the lungs during an asthma episode?

<p>Narrowed airways increase resistance to expiratory flow, causing air trapping and hyperinflation of the lungs.</p> Signup and view all the answers

What is the impact of hyperinflation on the diaphragm's function?

<p>It causes the diaphragm to flatten, which puts it at a mechanical disadvantage during breathing.</p> Signup and view all the answers

Identify the primary cause of inspiratory dyspnoea in asthma patients.

<p>Reduced expiratory airflow leads to hyperinflation, which causes difficulty inhaling due to residual lung volume.</p> Signup and view all the answers

What role do the accessory muscles play during asthma episodes?

<p>Accessory muscles are recruited to assist in inhalation by lifting the sternum and upper ribs due to increased work of breathing.</p> Signup and view all the answers

Discuss how acute airway inflammation affects the lungs.

<p>Airway inflammation leads to mucosal edema, tightening of smooth muscle, and mucus hypersecretion, all contributing to airway narrowing.</p> Signup and view all the answers

Explain the consequence of a low V/Q ratio in asthma.

<p>A low V/Q ratio leads to poor alveolar ventilation, resulting in inadequate oxygen replenishment and hypoxaemia.</p> Signup and view all the answers

What is the relationship between tidal volume and respiratory rate in lung hyperinflation?

<p>As tidal volume decreases in lung hyperinflation, the respiratory rate increases to maintain minute ventilation.</p> Signup and view all the answers

How does low partial pressure of oxygen affect respiratory rate?

<p>A low partial pressure of oxygen stimulates chemoreceptors, increasing the respiratory rate to improve alveolar oxygenation.</p> Signup and view all the answers

What are the typical auscultation findings during asthma exacerbations?

<p>Auscultation may reveal a widespread wheeze and a prolonged expiratory phase due to airflow obstruction.</p> Signup and view all the answers

What does a 'silent chest' signify in an asthma patient?

<p>A 'silent chest' is an alarming sign indicating severe bronchospasm or respiratory failure, requiring immediate medical intervention.</p> Signup and view all the answers

What features might a chest x-ray show in a patient with hyperinflated lungs?

<p>A chest x-ray may reveal a flattened diaphragm, more than 6 visible anterior ribs, and signs of hyperinflation with darker lung fields.</p> Signup and view all the answers

Explain the purpose of spirometry in assessing asthma.

<p>Spirometry measures airflow obstruction by determining the Forced Expiratory Volume in 1 second (FEV1) and Forced Vital Capacity (FVC).</p> Signup and view all the answers

What is the significance of mucus consistency in asthma patients?

<p>Asthma patients often have very viscous and mucoid sputum, which contributes to airway obstruction and difficulty in breathing.</p> Signup and view all the answers

In what scenarios is a chest x-ray necessary for asthma patients?

<p>A chest x-ray is necessary in cases of deteriorating life-threatening asthma or to rule out complications like pneumonia and pneumothorax.</p> Signup and view all the answers

What is the forced expiratory ratio (FER) and what are its normal values?

<p>The forced expiratory ratio (FER) is the ratio of FEV1 to FVC, with normal values being greater than 0.75 to 0.8 (or 75-80%).</p> Signup and view all the answers

How does airway obstruction in asthma affect FEV1 and FVC during an asthma episode?

<p>Airway obstruction in asthma typically results in a decreased FEV1 and may leave the FVC relatively unchanged, leading to a FER of less than 80% predicted.</p> Signup and view all the answers

What role does peak expiratory flow rate (PEF) play in asthma management?

<p>Peak expiratory flow rate (PEF) is used to measure maximum airflow during forced expiration and helps monitor changes in asthma severity and predict episodes.</p> Signup and view all the answers

Why might someone with asthma experience reduced exercise tolerance?

<p>Individuals with asthma may experience reduced exercise tolerance due to increased work of breathing from airway obstruction, leading to muscle fatigue from inadequate oxygenation.</p> Signup and view all the answers

How does hyperventilation during exercise affect patients with asthma?

<p>Hyperventilation during exercise can worsen air trapping and lead to hypoventilation, thereby decreasing arterial oxygen levels and worsening asthma symptoms.</p> Signup and view all the answers

What psychological effects may patients experience during an asthma episode?

<p>Patients may experience agitation and anxiety during asthma episodes due to fear of suffocation, hypoxia, or side effects from medication.</p> Signup and view all the answers

In what ways can avoidance of exercise be detrimental for individuals with asthma?

<p>Avoidance of exercise can lead to deconditioning of the cardiovascular and skeletal systems, which may ultimately decrease exercise tolerance and increase health risks.</p> Signup and view all the answers

What is the significance of monitoring personal best PEF for patients with asthma?

<p>Monitoring personal best PEF helps patients to identify changes in lung function, indicating worsening conditions or impending asthma episodes.</p> Signup and view all the answers

Flashcards

Sensitization

The initial exposure to an allergen, virus, or stimulus that triggers the immune system.

Mast cells

Immune cells that release chemicals like histamine and other inflammatory mediators, causing allergic reactions.

Immunoglobulin E (IgE)

A type of antibody that binds to allergens and triggers mast cell activation.

T helper 2 cells (Th2 cells)

Immune cells that help coordinate the immune response by producing signals that attract other immune cells to the area.

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Priming

The process where IgE binds to receptors on mast cells, making them ready to react to a future exposure to the allergen.

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What is asthma?

Asthma is a chronic obstructive lung disease characterized by intermittent airway obstruction, chronic inflammation, and airway hyperreactivity, causing symptoms such as wheezing, coughing, shortness of breath, and chest tightness.

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Asthma prevalence and mortality worldwide

The prevalence of asthma is higher in developed countries, but mortality rates are worse in less developed nations.

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What are the key pathophysiological features of asthma?

The pathophysiology of asthma involves episodic hyperreactivity of medium to small airways to triggers, leading to chronic airway inflammation, airway smooth muscle contraction (bronchospasm), mucosal edema, and mucus hypersecretion. These factors contribute to airway obstruction.

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Explain airway inflammation in asthma

Airway inflammation is a hallmark of asthma, involving the presence of inflammatory cells such as eosinophils and neutrophils, and the release of inflammatory mediators like leukotrienes and prostaglandins.

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What happens to mucus production during an asthma attack?

Mucus hypersecretion during an asthma episode is due to overgrowth of goblet cells, producing thick and light-colored secretions.

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What is allergic asthma?

Allergic asthma, also known as atopic or extrinsic asthma, is triggered by the initial exposure to allergens. This sensitization process leads to airway narrowing.

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What is the sensitization process in allergic asthma?

In allergic asthma, exposure to allergens sets off a complex series of events called sensitization, culminating in airway narrowing. This involves various immune cells, mediators, and inflammation.

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Prevalence of allergic asthma

Allergic asthma affects around 50-60% of asthma patients and is characterized by a complex sensitization process triggered by allergens.

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Airway Narrowing During Sleep

The narrowing of the airways during sleep or lying down. This can be due to factors such as the position of the body, muscle relaxation, and changes in airflow.

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Mucociliary Clearance

The process of moving mucus and debris out of the airways. It is normally active but can be impaired during sleep or when lying down.

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Tenacious Sputum Plugs

Thick, sticky mucus that can build up in the airways and cause coughing and difficulty breathing.

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Airway Remodeling

A process where the airways become permanently altered, leading to inflammation and damage to the lining of the airways.

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Breathlessness

The sensation of shortness of breath.

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Airway Inflammation

Inflammation of the lining of the airways, leading to swelling and narrowing of the airways.

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Hyperinflation of the Lungs

A condition where air becomes trapped in the alveoli (tiny air sacs in the lungs) due to narrowed airways, leading to difficulty breathing out.

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Work of Breathing

The effort involved in breathing, which can be increased in asthma due to airway narrowing and hyperinflation.

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How does forced expiration affect asthma?

The force used to exhale air during an asthma attack causes increased pressure inside the lungs. This pressure makes it harder for air to move through the airways, making the asthma worse.

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What is Extrinsic Asthma?

A type of asthma triggered by substances like pollen, dust mites, and pet dander, often leading to inflammation in the airways.

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What causes an overreaction in Extrinsic asthma?

The immune system overreacts to normally harmless substances such as pollen, causing airway inflammation in this type of asthma

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What is Intrinsic Asthma?

A type of asthma that is not related to allergies, often developing in adults and triggered by factors like pollution and infections.

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When does Intrinsic asthma typically occur?

It often develops in adults and is termed late-onset asthma.

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What triggers Intrinsic asthma?

Symptoms are not associated with an allergic reaction but other types of trigger, such as environmental pollutants, infections, or exercise.

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What is Exercise-induced Asthma?

A type of asthma that can occur after exercise, often indicating poorly controlled asthma or other health problems.

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What are the contributing factors to asthma?

Asthma is a complex condition that can be influenced by a variety of factors, including genetics, environment, and lifestyle.

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Lung Function

The ability of the lungs to expand and contract properly. This is impaired in asthma due to airway narrowing and hyperinflation.

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FEV1 (Forced Expiratory Volume in 1 second)

The volume of air forcefully exhaled in the first second after taking a deep breath. It's often reduced in asthma because of narrowed airways.

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FVC (Forced Vital Capacity)

The total volume of air that can be forcefully exhaled after taking a deep breath. It can be affected by asthma due to airway narrowing.

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Lung Hyperinflation

A process where the lungs become abnormally inflated, making it difficult for air to flow in and out.

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Increased Respiratory Rate

An increase in breathing rate, often a response to low oxygen levels (hypoxia) and/or increased demand for oxygen, as seen in asthma.

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Wheezing

The sound of air moving through narrowed airways, commonly heard in asthma. It can vary in intensity depending on severity.

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Chest X-ray (CXR)

An X-ray image of the chest that can help assess the lungs and identify potential complications in asthma like pneumonia or pneumothorax.

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Bronchial Thickening

Thickening of the airway walls due to inflammation and remodeling, a characteristic change seen in long-term asthma.

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Forced Expiratory Ratio (FER)

The ratio of forced expiratory volume in the first second (FEV1) to forced vital capacity (FVC). It is a useful indicator of airflow obstruction in the lungs.

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Peak Expiratory Flow Rate (PEF)

A simple test measuring the maximum airflow achieved during a forced expiration after a full inhalation. It is useful for monitoring changes in asthma severity.

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Airway Obstruction in Asthma

Airway narrowing or obstruction in asthma slows expiratory airflow, resulting in less air expelled in the first second and more air retained in the lungs.

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Increased Work of Breathing in Asthma

The increased work of breathing during an asthma episode due to airway narrowing, leading to more effort required to move air in and out of the lungs.

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Reduced Exercise Tolerance in Asthma

The inability of the body to meet the oxygen demands of exercise during an asthma episode due to reduced oxygen availability and increased work of breathing.

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Avoidance of Exercise in Asthma

Avoidance of exercise due to asthma triggers and breathlessness, leading to deconditioning and further reduction in exercise tolerance.

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Mental State During Asthma Episodes

Agitation and anxiety experienced during an asthma episode due to fear, low oxygen levels, or side effects of medication.

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Asthma

A condition affecting the lungs, characterized by inflammation and narrowing of the airways, causing breathing difficulties.

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Study Notes

Asthma

  • Asthma is a chronic lung disease characterized by intermittent airway obstruction, chronic inflammation, and hyperreactivity.
  • Symptoms include wheezing, coughing, shortness of breath, and chest tightness.
  • Globally, 339 million people have asthma.
  • In the UK, 5.4 million people receive treatment for asthma (including 1.1 million children) in 2020.
  • Asthma prevalence has decreased since the 1990s, but UK asthma mortality is still 50% higher than in any other European country.
  • Asthma prevalence is generally higher in more economically developed countries, but death rates are higher in less economically developed countries.
  • More males have childhood asthma, whereas more females develop persistent asthma into adulthood or develop it in adulthood.

Pathophysiology

  • Asthma is characterized by episodic hyperreactivity of the medium to small airways in response to triggers.
  • This leads to chronic airway inflammation, airway smooth muscle contraction (bronchospasm), mucosal edema, and mucus hypersecretion.
  • The hallmark of asthma is airway inflammation with infiltration of eosinophils or neutrophils (white blood cells).
  • Inflammatory mediators like leukotrienes and prostaglandins are also involved.
  • Mucus hypersecretion can occur due to goblet cell hypertrophy and hyperplasia, resulting in viscid and light-colored secretions.

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Description

Explore the key aspects of asthma, a chronic lung disease affecting millions globally. This quiz covers its symptoms, prevalence, and the underlying pathophysiological mechanisms. Gain an understanding of how environmental and developmental factors influence asthma in different populations.

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