Asthma Pathophysiology and Phenotypes

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Questions and Answers

What is a characteristic of patients with allergic asthma?

Often in adulthood

Respond less well to ICS

Not associated with allergy

Associated with a past and/or family history of allergic disease (correct)

What is a feature of non-allergic asthma?

Not associated with allergy (correct)

Associated with a past and/or family history of allergic disease

Respond well to ICS

Often in childhood

What can be revealed by examining the induced sputum of patients with allergic asthma?

IgG and neutrophils

IgE and/or eosinophilic airway inflammation (correct)

Neutrophils and macrophages

Lymphocytes and basophils

What is a type of medication used to treat asthma?

Sympathomimetic Agents Signup and view all the answers

What is the mechanism of bronchodilation promoted by cAMP?

Increase in intracellular cAMP Signup and view all the answers

What is a characteristic of airway wall in patients with severe asthma?

Structural changes with an increase in the amount and composition of extracellular matrix Signup and view all the answers

What is a type of medication that can be used to treat asthma?

Antimuscarinic Agents Signup and view all the answers

What is a potential outcome of airflow obstruction in patients with severe asthma?

Partial reversibility Signup and view all the answers

What is the primary mechanism of corticosteroids in treating asthma?

Inhibiting the production of inflammatory cytokines Signup and view all the answers

What is the characteristic of formoterol?

Full agonist with an onset of action similar to that of albuterol Signup and view all the answers

What is the purpose of combining ultralong acting β agonists with an ICS?

To mask symptoms of bronchial inflammation Signup and view all the answers

What is the effect of corticosteroids on airway obstruction?

They inhibit lymphocytic and eosinophilic mucosal inflammation Signup and view all the answers

What is the characteristic of salmeterol?

Partial agonist with an onset of action of ~ 30 minutes Signup and view all the answers

What is the mechanism of theophylline in treating asthma?

Relaxing airway smooth muscle directly Signup and view all the answers

What is the effect of corticosteroids on bronchial reactivity?

They decrease bronchial reactivity Signup and view all the answers

What is the duration of action of ultralong acting β agonists?

Once a day Signup and view all the answers

What is the duration of action of salmeterol and formoterol?

Long lasting bronchodilation (≥ 12 hours) Signup and view all the answers

Why are salmeterol and formoterol not used as monotherapy?

Due to increased risk of severe, life-threatening exacerbation and asthma-related death Signup and view all the answers

What is the characteristic of salmeterol and formoterol that allows them to achieve their long duration of action?

High lipid solubility Signup and view all the answers

What is the effect of combining salmeterol and formoterol with inhaled corticosteroids?

Increased asthma control Signup and view all the answers

What is the type of agents that include tiotropium, aclidinium, umeclidinium, and glycopyrrolate?

Long-acting antimuscarinic agents Signup and view all the answers

How are salmeterol and formoterol taken?

By inhalation Signup and view all the answers

What is the systemic side effect of salmeterol and formoterol?

Dose-dependent Signup and view all the answers

What is the indication for the use of tiotropium, aclidinium, umeclidinium, and glycopyrrolate?

COPD Signup and view all the answers

What is the typical duration of therapy for oropharyngeal candidiasis management?

3 to 10 days Signup and view all the answers

Why is it recommended to administer corticosteroids in the late afternoon for prevention of nocturnal asthma?

Because of the diurnal variation of endogenous corticosteroids Signup and view all the answers

What is the first choice of treatment for milder forms of oropharyngeal candidiasis?

Topical antimycotic therapies Signup and view all the answers

Why is tapering corticosteroid dose not necessary for short bursts of treatment?

Because any adrenal suppression is transient and rapidly reversible Signup and view all the answers

What is the advantage of administering corticosteroids in the morning for severe exacerbations?

It does not have any advantage Signup and view all the answers

What is the role of topical agents in oropharyngeal candidiasis management?

They are the standard treatment for uncomplicated oropharyngeal candidiasis Signup and view all the answers

What is the most effective way to avoid the systemic adverse effects of corticosteroid therapy?

Minimal systemic absorption of aerosol corticosteroids Signup and view all the answers

What is the cornerstone of chronic asthma therapy?

Aerosol corticosteroids Signup and view all the answers

What is the only therapy shown to reduce the risk of asthma death?

Aerosol corticosteroids Signup and view all the answers

What is a characteristic of products such as beclometasone dipropionate and budesonide?

They are equally effective if given in equipotent doses Signup and view all the answers

What is the mechanism of action of cromolyn sodium and nedocromil sodium?

Stabilization of mast cells and other cells Signup and view all the answers

In which patients is systemic therapy necessary?

Those who are refractory to topical treatment Signup and view all the answers

What is an example of systemic therapy for OPC?

Fluconazole Signup and view all the answers

What is a characteristic of cromolyn sodium and nedocromil sodium?

They are stable but extremely insoluble salts Signup and view all the answers

Study Notes

Pathophysiological Characteristics of Asthma

Refers to structural changes, including an alteration in the amount and composition of extracellular matrix in the airway wall, leading to airflow obstruction
In patients with more severe asthma, some phenotype-guided treatments are available, but may become only partially reversible

Asthma Phenotypes

Allergic Asthma:
- Most easily recognized phenotype
- Associated with a past and/or family history of allergic disease (e.g. eczema, allergic rhinitis, or food or drug allergy)
- Patients usually respond well to inhaled corticosteroid (ICS) treatment
Non-Allergic Asthma:
- Not associated with allergy
- Often in childhood
- Cellular profile of sputum may be neutrophilic, eosinophilic, or contain only a few inflammatory cells (paucigranulocytic)
- Patients with non-allergic asthma often respond less well to ICS

Asthma Medications

Sympathomimetic Agents: Beta Agonists
- Promote bronchodilation by increasing cAMP
- Examples: Salmeterol, Formoterol, Indacaterol, Olodaterol, Vilanterol, and Bambuterol
Methylxanthines:
- Theophylline
- Duration of therapy usually ranges from 3 to 10 days, but longer therapy may be necessary for severe exacerbations
Antimuscarinic Agents:
- Longer acting antimuscarinic agents (LAMA), including Tiotropium, aclidinium, umeclidinium, and glycopyrrolate
Corticosteroids:
- Inhaled, Systemic
- Broad anti-inflammatory efficacy, mediated in part by inhibition of production of inflammatory cytokines
Stabilizers of Mast and Other Cells:
- Cromolyn and Nedocromil
- No bronchodilatory effect

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Description

Learn about the structural changes and airflow obstruction in asthma, as well as the different phenotypes, including allergic asthma and its associated characteristics.