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?

    <p>Sympathomimetic Agents</p> Signup and view all the answers

    What is the mechanism of bronchodilation promoted by cAMP?

    <p>Increase in intracellular cAMP</p> Signup and view all the answers

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

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

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

    <p>Antimuscarinic Agents</p> Signup and view all the answers

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

    <p>Partial reversibility</p> Signup and view all the answers

    What is the primary mechanism of corticosteroids in treating asthma?

    <p>Inhibiting the production of inflammatory cytokines</p> Signup and view all the answers

    What is the characteristic of formoterol?

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

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

    <p>To mask symptoms of bronchial inflammation</p> Signup and view all the answers

    What is the effect of corticosteroids on airway obstruction?

    <p>They inhibit lymphocytic and eosinophilic mucosal inflammation</p> Signup and view all the answers

    What is the characteristic of salmeterol?

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

    What is the mechanism of theophylline in treating asthma?

    <p>Relaxing airway smooth muscle directly</p> Signup and view all the answers

    What is the effect of corticosteroids on bronchial reactivity?

    <p>They decrease bronchial reactivity</p> Signup and view all the answers

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

    <p>Once a day</p> Signup and view all the answers

    What is the duration of action of salmeterol and formoterol?

    <p>Long lasting bronchodilation (≥ 12 hours)</p> Signup and view all the answers

    Why are salmeterol and formoterol not used as monotherapy?

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

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

    <p>High lipid solubility</p> Signup and view all the answers

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

    <p>Increased asthma control</p> Signup and view all the answers

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

    <p>Long-acting antimuscarinic agents</p> Signup and view all the answers

    How are salmeterol and formoterol taken?

    <p>By inhalation</p> Signup and view all the answers

    What is the systemic side effect of salmeterol and formoterol?

    <p>Dose-dependent</p> Signup and view all the answers

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

    <p>COPD</p> Signup and view all the answers

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

    <p>3 to 10 days</p> Signup and view all the answers

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

    <p>Because of the diurnal variation of endogenous corticosteroids</p> Signup and view all the answers

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

    <p>Topical antimycotic therapies</p> Signup and view all the answers

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

    <p>Because any adrenal suppression is transient and rapidly reversible</p> Signup and view all the answers

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

    <p>It does not have any advantage</p> Signup and view all the answers

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

    <p>They are the standard treatment for uncomplicated oropharyngeal candidiasis</p> Signup and view all the answers

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

    <p>Minimal systemic absorption of aerosol corticosteroids</p> Signup and view all the answers

    What is the cornerstone of chronic asthma therapy?

    <p>Aerosol corticosteroids</p> Signup and view all the answers

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

    <p>Aerosol corticosteroids</p> Signup and view all the answers

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

    <p>They are equally effective if given in equipotent doses</p> Signup and view all the answers

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

    <p>Stabilization of mast cells and other cells</p> Signup and view all the answers

    In which patients is systemic therapy necessary?

    <p>Those who are refractory to topical treatment</p> Signup and view all the answers

    What is an example of systemic therapy for OPC?

    <p>Fluconazole</p> Signup and view all the answers

    What is a characteristic of cromolyn sodium and nedocromil sodium?

    <p>They are stable but extremely insoluble salts</p> 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.

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