Asthma
110 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which environmental factor is NOT mentioned as a potential trigger for asthma?

  • Dust mites
  • Exercise-induced heat (correct)
  • Tobacco smoke
  • Air pollution
  • Which of the following allergens is associated with mold exposure?

  • Cats
  • Cockroach
  • Dust mites
  • Pollens (correct)
  • What is the relationship between respiratory infections and asthma?

  • Respiratory infections are beneficial for asthma patients.
  • Respiratory infections lead to permanent asthma.
  • Respiratory infections serve as a trigger for asthma exacerbation. (correct)
  • Respiratory infections have no effect on asthma symptoms.
  • Which condition describes an asthma response related to high humidity?

    <p>Non-allergic asthma</p> Signup and view all the answers

    Which environmental factor is primarily associated with allergic asthma?

    <p>Airborne allergens</p> Signup and view all the answers

    Which type of asthma is NOT influenced by environmental factors?

    <p>Genetic asthma</p> Signup and view all the answers

    Which of the following is NOT considered an environmental trigger for asthma?

    <p>Genetic predisposition</p> Signup and view all the answers

    What is one way that tobacco smoke acts as a trigger for asthma?

    <p>It leads to airway inflammation.</p> Signup and view all the answers

    How does outdoor air pollution contribute to asthma?

    <p>It induces airway hyperresponsiveness.</p> Signup and view all the answers

    Which environmental factor is linked to chronic airway inflammation in asthmatic individuals?

    <p>Mold exposure</p> Signup and view all the answers

    What role do pests, like cockroaches, play in asthma development?

    <p>Their waste products can trigger asthma symptoms.</p> Signup and view all the answers

    Which of the following is an effect of cleaning and disinfection on asthma?

    <p>It may introduce respiratory irritants.</p> Signup and view all the answers

    Which of the following is considered a primary environmental trigger for asthma exacerbations?

    <p>Exposure to high levels of air pollution</p> Signup and view all the answers

    What is the most effective method for assessing an individual's future risk of asthma exacerbations?

    <p>Measuring FEV1% before and periodically after initiating treatment</p> Signup and view all the answers

    Which factor is least likely to be associated with asthma exacerbations?

    <p>Consuming high-fat foods</p> Signup and view all the answers

    In the context of asthma management, when are risk factors typically assessed?

    <p>At diagnosis and regularly afterward</p> Signup and view all the answers

    What is a primary characteristic of a mild asthma exacerbation?

    <p>Slight increase in daytime symptoms</p> Signup and view all the answers

    Which statement about asthma exacerbation severity is true?

    <p>It is graded on symptoms and physical examination parameters</p> Signup and view all the answers

    Which of the following triggers is most likely to activate mast cells and Th2 cells in susceptible individuals with asthma?

    <p>Respiratory viral infections</p> Signup and view all the answers

    What is the primary outcome of the interaction between inflammatory cells and airway hyperresponsiveness in asthma patients?

    <p>Reversible airflow obstruction</p> Signup and view all the answers

    Which mediator is NOT typically associated with the inflammatory response in asthma exacerbations?

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

    In the context of asthma, what does airway hyperresponsiveness primarily lead to upon exposure to triggers?

    <p>Increased episodes of bronchoconstriction</p> Signup and view all the answers

    Individuals with asthma may experience exacerbations due to exposure to which of the following environmental factors?

    <p>Strong odors and pollutants</p> Signup and view all the answers

    What role do eosinophils play in the inflammatory process of asthma?

    <p>They contribute to airway tissue injury</p> Signup and view all the answers

    Which of the following statements is true regarding the prevalence of asthma among different age groups?

    <p>Asthma affects individuals across all age groups.</p> Signup and view all the answers

    What distinguishes late-onset eosinophilic asthma from early-onset allergic asthma?

    <p>It exhibits less allergic symptomatology and is often corticosteroid-refractory.</p> Signup and view all the answers

    Which characteristic is associated with exercise-induced asthma?

    <p>Mast cell activation plays a key role in its pathophysiology.</p> Signup and view all the answers

    What is a common genetic marker associated with early-onset allergic asthma?

    <p>17q12</p> Signup and view all the answers

    Which phenotype of asthma is most likely to show significant response improvements with weight loss?

    <p>Obesity-related asthma</p> Signup and view all the answers

    Which of the following is a unique feature of neutrophilic asthma?

    <p>Typically associated with a low FEV1 and significant airway trapping.</p> Signup and view all the answers

    Which special form of asthma involves symptoms primarily during nighttime?

    <p>Nocturnal asthma</p> Signup and view all the answers

    Which phenotype of asthma is characterized by significant responsiveness to allergens and elevated IgE levels?

    <p>Allergic asthma</p> Signup and view all the answers

    What is a common characteristic of non-allergic asthma compared to other asthma phenotypes?

    <p>Unrelated to IgE-mediated mechanisms</p> Signup and view all the answers

    Which phenotype of asthma is most likely to be exacerbated by physical activity or exercise?

    <p>Exercise-induced bronchoconstriction</p> Signup and view all the answers

    In terms of asthma phenotypes, which condition is primarily linked to occupational exposures and can manifest with specific symptoms at work?

    <p>Occupational asthma</p> Signup and view all the answers

    What is often a defining feature of severe asthma compared to other asthma phenotypes?

    <p>Significant airway obstruction that may not be fully reversible</p> Signup and view all the answers

    Which of the following best describes the approach to managing different asthma phenotypes?

    <p>Management should be tailored based on specific triggers and inflammatory pathways</p> Signup and view all the answers

    What is the primary consequence of chronic airway inflammation in asthma patients?

    <p>Increased airway smooth muscle mass</p> Signup and view all the answers

    Which of the following is a primary characteristic of airway remodeling in asthmatic individuals?

    <p>Increased goblet cell hyperplasia</p> Signup and view all the answers

    What effect does airway remodeling have on bronchodilator response?

    <p>It causes fixed narrowing of the airway</p> Signup and view all the answers

    Which host factor is most significantly associated with the development of asthma?

    <p>Positive family history of asthma</p> Signup and view all the answers

    The term 'airway hyperresponsiveness' specifically refers to which of the following?

    <p>The tendency for airways to narrow in response to non-specific triggers</p> Signup and view all the answers

    What is a potential outcome of increased matrix deposition in the airway wall due to asthma?

    <p>Thickening of the airway walls</p> Signup and view all the answers

    What characterizes episodic asthma in patients?

    <p>Asymptomatic between exacerbations</p> Signup and view all the answers

    Which spirometry result indicates reversible airflow limitation consistent with asthma?

    <p>FEV1 increased by 12% and 200 ml after bronchodilator</p> Signup and view all the answers

    What distinguishes persistent asthma from episodic asthma?

    <p>Presence of chronic wheeze and breathlessness</p> Signup and view all the answers

    Under what condition might wheezing be absent in a patient experiencing asthma?

    <p>In cases of both very mild and very severe obstruction</p> Signup and view all the answers

    What is a common sign of severe airway obstruction in asthma patients?

    <p>Marked limitation of airflow resulting in a silent chest</p> Signup and view all the answers

    What does a diurnal PEFR variability greater than 20% suggest?

    <p>Suggests a diagnosis of asthma</p> Signup and view all the answers

    What is a common characteristic of asthma symptoms in children who are atopic?

    <p>Symptoms typically worsen at night</p> Signup and view all the answers

    Which genetic factor is most commonly associated with early-onset allergic asthma?

    <p>Filaggrin mutations</p> Signup and view all the answers

    What role does the IL4 gene play in the context of asthma?

    <p>It contributes to the differentiation of Th2 cells.</p> Signup and view all the answers

    Which of the following genetic variations is linked to a reduced response to asthma medications in certain phenotypes?

    <p>IL13 gene SNPs</p> Signup and view all the answers

    Which genetic factor is specifically implicated in the persistence of asthma symptoms into adulthood?

    <p>IL25 gene variations</p> Signup and view all the answers

    The association of TLR (Toll-like receptor) polymorphisms with asthma susceptibility suggests what about genetic influence?

    <p>They modify immune response to environmental allergens.</p> Signup and view all the answers

    Which genetic variant is associated with significantly higher levels of IgE in asthma patients?

    <p>IL4R gene polymorphisms</p> Signup and view all the answers

    Which factor is primarily linked to the development of adult-onset asthma?

    <p>Non-atopic triggers in older age</p> Signup and view all the answers

    What is the significance of a patient's family history in diagnosing asthma?

    <p>It may suggest a genetic predisposition to asthma</p> Signup and view all the answers

    Which genes are most commonly associated with early-onset allergic asthma?

    <p>IL4 and IL13</p> Signup and view all the answers

    What role do environmental interactions play in the genetics of asthma?

    <p>They modify the expression of asthma-related genes</p> Signup and view all the answers

    Which of the following is most likely to be a genetic marker for asthma severity?

    <p>ADAM33</p> Signup and view all the answers

    Which subgroup of asthmatics is particularly influenced by genetic factors?

    <p>Children with early-onset allergic asthma</p> Signup and view all the answers

    What is a common characteristic of asthma related to genetic inheritance?

    <p>It often shows polygenic influences with multiple genes involved</p> Signup and view all the answers

    Which genetic marker is specifically associated with early-onset allergic asthma?

    <p>17q12</p> Signup and view all the answers

    What role do Th2-related genes play in asthma phenotypes?

    <p>They contribute to allergic responses and airway inflammation.</p> Signup and view all the answers

    Which asthma phenotype is characterized by a lack of Th2 cytokines?

    <p>Obesity-related asthma</p> Signup and view all the answers

    In the context of asthma genetics, what does the IL-5 antibody response indicate?

    <p>A predisposition to eosinophilic inflammation.</p> Signup and view all the answers

    What is a significant genetic feature associated with neutrophilic asthma?

    <p>Elevated levels of IL-8</p> Signup and view all the answers

    Which genetic or biomarker characteristic is commonly associated with asthma responses in women?

    <p>Correlations with 17q12 genetic variations</p> Signup and view all the answers

    Which genetic predisposition is most notably linked to asthma development?

    <p>Positive family history of asthma</p> Signup and view all the answers

    What host factor contributes to the propensity for developing asthma-related symptoms?

    <p>Genetic susceptibility to atopy</p> Signup and view all the answers

    In terms of asthma genetics, which gender is more significantly associated with the condition during childhood?

    <p>Males, particularly in early childhood</p> Signup and view all the answers

    Which of the following statements about family history and asthma is most accurate?

    <p>A positive family history increases the risk of asthma development</p> Signup and view all the answers

    What mechanism potentially explains the genetic influence of asthma in families?

    <p>Polygenic risk factors combined with environmental triggers</p> Signup and view all the answers

    Which risk factor, when combined with genetic predisposition, is most likely to enhance the severity of asthma symptoms?

    <p>Low socioeconomic status</p> Signup and view all the answers

    What is the recommended step in asthma management for patients with low exacerbation risk and symptoms controlled by low dose ICS?

    <p>Continue with low dose ICS</p> Signup and view all the answers

    Which treatment approach is appropriate for a patient experiencing uncontrolled symptoms despite a low dose ICS and leukotriene receptor antagonist?

    <p>Increase the inhaled corticosteroid dosage</p> Signup and view all the answers

    In asthma management, what is the primary role of tiotropium in patients with uncontrolled symptoms?

    <p>To provide additional bronchodilation</p> Signup and view all the answers

    What is essential to assess in the management of asthma over time?

    <p>The peak expiratory flow rate (PEFR)</p> Signup and view all the answers

    What constitutes symptom control in asthma management?

    <p>The frequency and severity of symptoms experienced</p> Signup and view all the answers

    Which of the following medications is considered a cornerstone of asthma therapy?

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

    What is an effective non-pharmacological strategy for managing asthma symptoms in patients?

    <p>Education and awareness about asthma triggers</p> Signup and view all the answers

    What is the primary purpose of short-acting inhaled β2 agonists (SABAs) in asthma management?

    <p>To provide quick relief of symptoms</p> Signup and view all the answers

    In which asthma management step is the long-acting anticholinergic tiotropium recommended as an add-on option?

    <p>Step 4 or 5</p> Signup and view all the answers

    Which of the following side effects is commonly reported with the initial use of short-acting inhaled β2 agonists (SABAs)?

    <p>Tremor and tachycardia</p> Signup and view all the answers

    What is the purpose of the stepwise approach in asthma treatment management?

    <p>To ensure ongoing assessment and adjustment of treatment</p> Signup and view all the answers

    When should regular daily controller treatment ideally be initiated for asthma patients?

    <p>Immediately after diagnosis</p> Signup and view all the answers

    What is the primary long-term management goal for asthma care?

    <p>Symptom control and reduction of exacerbation risk</p> Signup and view all the answers

    Which of the following is essential for all asthma patients to have as part of their management plan?

    <p>Reliever medication</p> Signup and view all the answers

    What role does the treatment of modifiable risk factors play in asthma management?

    <p>It addresses underlying causes of airway inflammation</p> Signup and view all the answers

    In managing asthma, what is the primary purpose of using controller medications?

    <p>To prevent symptoms and reduce inflammation long-term</p> Signup and view all the answers

    Why is the measurement of exhaled nitric oxide (FeNO) important in asthma management?

    <p>It serves as a measure of eosinophilic airway inflammation in glucocorticoid-naive patients</p> Signup and view all the answers

    What is a critical factor that affects the management of asthma in patients with co-morbidities?

    <p>They can complicate asthma treatment and worsen symptoms</p> Signup and view all the answers

    What is a key characteristic of patients with episodic asthma during symptom-free periods?

    <p>Remaining asymptomatic until exposure to allergens</p> Signup and view all the answers

    Which spirometry finding is consistent with asthma diagnosis after bronchodilator administration?

    <p>An increase in FEV1 by 12% and 200 ml</p> Signup and view all the answers

    How does persistent asthma typically differ from episodic asthma?

    <p>Persistent asthma involves continuous symptoms and chronic wheeze</p> Signup and view all the answers

    What condition may lead to wheezing being absent despite airway obstruction?

    <p>Severe airway obstruction</p> Signup and view all the answers

    During an acute exacerbation of asthma, which physical sign may be observed?

    <p>Decreased breath sounds</p> Signup and view all the answers

    What pattern is typically observed in diurnal PEFR variability in asthmatic patients?

    <p>Variability greater than 20% on most days</p> Signup and view all the answers

    What is a common trigger for exacerbations of asthma symptoms in atopic individuals?

    <p>Viral respiratory infections</p> Signup and view all the answers

    Which of the following special forms of asthma is typically characterized by symptoms occurring primarily at night?

    <p>Nocturnal asthma</p> Signup and view all the answers

    What distinguishes neutrophilic asthma from other asthma phenotypes?

    <p>Presence of neutrophilic inflammation</p> Signup and view all the answers

    Which phenotype is primarily exacerbated by physical activity or exercise?

    <p>Exercise-induced asthma</p> Signup and view all the answers

    Which asthma phenotype is most often linked to occupational exposures, presenting specific symptoms at work?

    <p>Occupational asthma</p> Signup and view all the answers

    What is a common characteristic of late-onset eosinophilic asthma compared to early-onset asthma?

    <p>Less likelihood of family history</p> Signup and view all the answers

    Which phenotype of asthma is recognized for significant responsiveness to environmental allergens and higher IgE levels?

    <p>Allergic asthma</p> Signup and view all the answers

    Which of the following is a defining feature of severe asthma compared to other asthma phenotypes?

    <p>Significant respiratory symptoms even with treatment</p> Signup and view all the answers

    What is a common characteristic of non-allergic asthma in contrast to other asthma phenotypes?

    <p>Absence of atopic history</p> Signup and view all the answers

    Which special form of asthma is specifically characterized by a predominant response to environmental allergens along with elevated IgE levels?

    <p>Allergic asthma</p> Signup and view all the answers

    Exercise-induced asthma typically shows response patterns related to which of the following?

    <p>Symptoms triggered primarily by cold air</p> Signup and view all the answers

    Study Notes

    Asthma Triggers

    • Common triggers include tobacco smoke, dust mites, outdoor air pollution, pests (e.g., cockroaches, mice), pets, mold, cleaning products, and infections.

    Pathogenesis of Asthma

    • Airway inflammation is crucial, leading to airway hyperresponsiveness, which causes excessive narrowing of airways in response to minor triggers.
    • Chronic airway inflammation results in airway remodeling, characterized by changes in cellular and molecular components, including:
      • Epithelial detachment
      • Subepithelial fibrosis
      • Increased airway smooth muscle mass
      • Goblet cell hyperplasia
      • Angiogenesis and airway edema
      • Thickening of airway walls with matrix deposition and cartilage abnormalities
    • Structural changes cause fixed airway narrowing and diminish bronchodilator responsiveness.

    Risk Factors for Asthma

    • Host factors: Genetic predisposition (family history), atopy, gender
    • Environmental factors: Allergens (pets, dust mites, mold), air pollution, viral respiratory infections, weather changes, tobacco smoke, diet, certain medications (NSAIDs, aspirin), and emotional stress.

    Types and Phenotypes of Asthma

    • Classification: Previously extrinsic (allergic) vs. intrinsic asthma; now includes non-allergic forms categorized by phenotypes:
      • Early-onset Allergic Asthma: Affects children and is often associated with allergies and eczema.
      • Late-onset Eosinophilic Asthma: Found in adults; may be resistant to corticosteroids.
      • Exercise-Induced Asthma: Triggered by physical activity.
      • Obesity-Related Asthma: More common in women; highly symptomatic.
      • Neutrophilic Asthma: Low FEV1; features sputum neutrophilia.

    Special Forms of Asthma

    • Includes nocturnal asthma, occupational asthma, aspirin-induced asthma, steroid-resistant asthma, cough-variant asthma, and asthma during pregnancy.

    Clinical Picture of Asthma

    • Symptoms include wheezing, breathlessness, cough, and chest tightness.
    • Daytime symptoms occurring more than twice a week indicate suboptimal control.
    • Nighttime awakenings and need for rescue medications signify worsening control.

    Assessment and Severity Classification

    • Severity based on symptoms, lung function, and variability: classified as intermittent, mild persistent, moderate persistent, or severe persistent.
    • Lung function is measured using FEV1%, with assessments made before treatment, after 3-6 months, and yearly for ongoing risk evaluation.

    Asthma Exacerbation

    • Defined as a significant worsening of symptoms or lung function; categorized as mild, moderate, severe, or very severe (life-threatening).
    • Most acute exacerbations occur in those with poorly controlled asthma over several days.

    Asthma Management

    • Effective management requires understanding asthma pathogenesis, classification, and appropriate intervention strategies based on severity and exacerbation risk.

    Environmental Factors Influencing Asthma

    • Common allergens include pets, dust mites, cockroaches, molds, and pollens.
    • Air pollution, respiratory infections (especially viral), and weather changes can trigger asthma symptoms.
    • Tobacco smoke, dietary habits, certain medications (e.g., NSAIDs, aspirin, beta-blockers), and emotional stress also play a role.

    Types and Phenotypes of Asthma

    • Asthma is now classified into non-allergic and allergic phenotypes.
    • Early-onset allergic asthma: Mild to severe symptoms, often accompanied by conditions like eczema and allergic rhinitis; responsive to corticosteroids and Th2-targeted therapies.
    • Late-onset eosinophilic asthma: Often severe with a history of sinusitis; corticosteroid-refractory; responds to therapies targeting IL-5 and cysteinyl leukotrienes.
    • Exercise-induced asthma: Symptoms triggered by physical activity; responds to corticosteroids and beta agonists.
    • Obesity-related asthma: Primarily affects women; characterized by airway hyperresponsiveness; management focuses on weight loss.
    • Neutrophilic asthma: Low FEV1 and significant air trapping; associated with sputum neutrophilia and the IL-8 pathway; possible response to macrolides.

    Special Forms of Asthma

    • Nocturnal asthma: Symptoms worsen at night.
    • Intermittent asthma: Symptoms vary significantly over time.
    • Occupational asthma: Triggered by workplace exposures.
    • Aspirin-induced asthma: Related to the use of aspirin.
    • Steroid-resistant asthma: Doesn't respond to routine corticosteroid therapy.
    • Cough-variant asthma: Dominated by chronic cough.
    • Asthma during pregnancy: Requires special management considerations.

    Clinical Picture of Asthma

    • Symptoms include wheezing, breathlessness, cough, and chest tightness.
    • Asthma often exhibits a pattern of episodic or persistent symptoms.
    • Exacerbations can be triggered by viral infections or allergen exposure.
    • Symptoms may worsen at night or seasonally.

    Pathogenesis of Asthma

    • Chronic airway inflammation involves mast cells, CD4-T lymphocytes, eosinophils, and airway epithelial cells.
    • Activation of mast cells and Th2 cells releases mediators like histamine and leukotrienes, leading to inflammation.
    • Chronic inflammation may cause airway remodeling, characterized by:
      • Epithelial detachment and subepithelial fibrosis.
      • Increased airway smooth muscle mass and goblet cell hyperplasia.
      • Structural changes in the airway wall, resulting in narrowed airways and reduced bronchodilator response.

    Risk Factors for Asthma Development

    • Genetic predisposition and positive family history of asthma are significant.
    • Atopy and gender also influence the likelihood of developing asthma.
    • Symptoms can be episodic, often exacerbated by viral infections or allergen exposure.

    Asthma Diagnosis

    • Diagnosis relies on symptom history, physical examination, and lung function tests.
    • Spirometry is essential to assess severity and variability of airflow limitation.
    • Reversibility tests: A positive response to bronchodilators (12% increase in FEV1) supports asthma diagnosis.
    • Peak expiratory flow rate (PEFR) tests can indicate variability and confirm diagnosis.

    Asthma Triggers

    • Common triggers include tobacco smoke, dust mites, outdoor air pollution, pests (e.g., cockroaches, mice), pets, mold, cleaning and disinfection products, and infections.

    Pathogenesis of Asthma

    • Chronic airway inflammation contributes to airway hyperresponsiveness, causing excessive narrowing in response to low-impact triggers.
    • Airway remodeling involves permanent structural changes, including:
      • Epithelial detachment
      • Subepithelial fibrosis
      • Increased airway smooth muscle mass
      • Goblet cell and mucus gland hyperplasia
      • Angiogenesis and airway edema
      • Thickened airway wall and altered elasticity

    Risk Factors for Asthma

    • Host factors: Genetic predisposition (family history), atopy, gender.
    • Environmental factors: Allergens (pets, dust mites, cockroaches, molds, pollens), air pollution, viral infections, weather changes, tobacco smoke, diet, specific drugs (NSAIDs, aspirin, beta-blockers), and emotional stress.

    Types and Phenotypes of Asthma

    • Asthma is now classified into various phenotypes rather than just extrinsic and intrinsic. Key phenotypes include:
      • Early-onset allergic asthma: Often associated with other allergic diseases, specific IgE production, responsive to corticosteroids.
      • Late-onset eosinophilic asthma: Often refractory to corticosteroids, characterized by adult onset and conditions like sinusitis.
      • Exercise-induced asthma: Symptoms triggered by physical activity.
      • Obesity-related asthma: More common in women and linked with significant airway hyperresponsiveness.
      • Neutrophilic asthma: Associated with low FEV1 and sputum neutrophilia.

    Special Forms of Asthma

    • Nocturnal asthma, intermittent asthma, occupational asthma, aspirin-induced asthma, steroid-resistant asthma, cough-variant asthma, asthma in pregnancy.

    Clinical Picture of Asthma

    • Symptoms include wheezing, breathlessness, coughing, and chest tightness, often worsening at night or early morning.
    • Episodes may be episodic or persistent and improve with treatment.

    Diagnosis of Asthma

    • Based on history, symptom patterns, physical examination, and physiological assessment:
      • Spirometry reveals obstructive patterns with variability; reversibility tests indicate asthma if FEV1 increases significantly after bronchodilator use.
      • Peak expiratory flow rate (PEFR) variability exceeding 20% on multiple days suggests a diagnosis of asthma.

    Management and Exacerbation

    • Understanding the management plan is essential for different asthma stages and addressing asthma exacerbations effectively.
    • Asthma is one of the most prevalent respiratory conditions globally, impacting all age groups and associated with significant disability.

    Asthma Management

    • LABA (Long-Acting Beta Agonist) and tiotropium are options for controlling asthma.
    • Anti-IgE and Anti-IL5 therapies are used for specific asthma management.
    • Low-dose inhaled corticosteroids (ICS) are recommended for patients with exacerbation risk.
    • Leukotriene receptor antagonists (LTRA) can be added for medium/high treatment plans.
    • Options for long-term management include SABA (short-acting beta agonist) as needed and low-dose ICS/formoterol for quick relief.

    Non-Pharmacological Therapy

    • Education on asthma management is essential.
    • Avoidance of known triggers can prevent exacerbations.
    • Smoking cessation is crucial for managing asthma severity.
    • Annual influenza vaccination is recommended for at-risk patients.
    • Allergen immunotherapy may benefit patients with specific allergies.

    Assessing Asthma Control

    • Control assessment includes evaluating symptoms and response to treatment adjustments.
    • Symptom control categorizes asthma as controlled, partly controlled, or uncontrolled.
    • Broncho-provocation tests assess airway reactivity in patients with normal lung functions.
    • Elevated exhaled nitric oxide (FeNO) levels support asthma diagnosis and predict glucocorticoid response.
    • Skin prick testing evaluates allergic status.

    Laboratory and Radiological Assessment

    • Peripheral blood eosinophilia and elevated serum IgE levels assist in asthma diagnosis.
    • Chest X-ray rules out other conditions and should be typically normal unless complications arise like hyperinflation or pneumothorax.

    Differential Diagnosis for Asthma

    • COPD, bronchitis, bronchopneumonia, and foreign body aspiration can mimic asthma symptoms.
    • Other conditions include gastroesophageal reflux disease (GERD), rhinosinusitis, congestive heart failure, and pulmonary embolism.

    Long-Term Management Goals

    • Aim for symptom control, reduced exacerbation risk, and minimized medication side effects.
    • All asthma patients should have a reliever medication.
    • Address modifiable risk factors, including rhinitis and anxiety, as part of asthma management.

    Pharmacological Therapy

    • Relievers include SABA, anticholinergics, and short-acting oral beta agonists.
    • Controller drugs encompass inhaled and systemic corticosteroids, LABA, LTRA, LAMA, and biological therapies.
    • Stepwise treatment adjustment should be based on ongoing assessment of symptoms and lung function.

    Asthma Action Plan (AAP)

    • Preferred treatments are determined by asthma severity and control levels, following a stepwise approach.
    • Inhaled corticosteroids (ICS) are cornerstones of asthma therapy.
    • SABA should be used sparingly as a quick relief option, being cautious of overuse indicating poor control.

    Clinical Presentation of Asthma

    • Asthma symptoms can vary from episodic, often seen in younger patients, to persistent symptoms in older individuals.
    • Wheezing is typically expiratory and may not always be present; severe obstruction can lead to a "silent chest."
    • Symptoms often worsen at night or with seasonal changes.

    Asthma Diagnosis

    • Diagnosis relies on patient history, physical exams, and lung function measurements.
    • Pulmonary function tests show reversible airflow limitation indicating asthma if FEV1 increases significantly after bronchodilator use.
    • Peak expiratory flow rate (PEFR) variability supports the asthma diagnosis if notable diurnal changes are observed.

    Environmental Factors

    • Key allergens include pets, dust mites, cockroaches, molds, and pollens.
    • Air pollution and respiratory infections, especially viral, are significant contributors.
    • Weather changes, such as cold, dry air or high humidity, impact asthma severity.
    • Tobacco smoke, diet, and certain medications (NSAIDs, aspirin, beta-blockers) can trigger asthma symptoms.
    • Emotional factors may also influence asthma.

    Types and Phenotypes of Asthma

    • Historically categorized as extrinsic (allergic) or intrinsic asthma; now intrinsic is termed non-allergic asthma with multiple phenotypes.

    Phenotypes of Asthma

    • Early-onset allergic (extrinsic) asthma:

      • Onset during childhood; associated with other allergic diseases (eczema, nasal allergies).
      • Key indicators: Specific IgE, Th2 cytokines, responds well to corticosteroids.
    • Late-onset eosinophilic asthma:

      • Occurs in adults; less allergic, often severe with sinusitis.
      • Characterized by eosinophilia and refractory to corticosteroids, responds to IL-5 antibodies.
    • Exercise-induced asthma:

      • Symptoms triggered during physical activity; mild to intermittent.
      • Managed with cysteinyl leukotriene modifiers and beta agonists.
    • Obesity-related asthma:

      • Affect primarily women; significantly symptomatic with unclear mechanisms.
      • Response to weight loss therapy noted.
    • Neutrophilic asthma:

      • Presents with low FEV1 and increased air trapping.
      • Associated with sputum neutrophilia; may respond to macrolides.

    Special Forms of Asthma

    • Nocturnal asthma, intermittent asthma, occupational asthma.
    • Aspirin-induced asthma and steroid-resistant asthma.
    • Cough-variant asthma, including asthma occurring during pregnancy.

    Clinical Picture

    • Common symptoms encompass wheezing, breathlessness, cough, and chest tightness.
    • Episodes can arise at any age, either episodically or persistently.
    • Patients with episodic asthma typically feel well between attacks; exacerbations often follow viral infections or allergen exposure.
    • Symptoms may worsen at night and during certain seasons.
    • Persistent asthma is frequent in older adults, exhibiting chronic wheezing and breathlessness.

    Asthma Diagnosis

    • Relies on patient history, symptom patterns, and physical examination.
    • Physiological assessment:
      • Spirometry measures lung function, revealing obstructive patterns during attacks, normal between.
      • Reversibility test: A 12% or 200 ml increase in FEV1 post-bronchodilator indicates reversible airflow limitation.
      • Peak expiratory flow rate (PEFR) variability test: More than 20% diurnal variability suggests asthma.

    Asthma Triggers

    • Common triggers include tobacco smoke, dust mites, outdoor air pollution, pests (e.g., cockroaches), pets, mold, and cleaning products.

    Airway Hyperresponsiveness

    • Caused by airway inflammation, leading to excessive narrowing in response to minor triggers.
    • Central to asthma diagnosis and symptom development.

    Airway Remodeling

    • Chronic inflammation results in fixed structural changes in airway:
      • Epithelial detachment, subepithelial fibrosis, increased smooth muscle mass.
      • Goblet cell hyperplasia, angiogenesis, airway edema, matrix deposition.

    Risk Factors for Asthma Development

    • Host factors: genetic predisposition (family history), atopy, and gender are principal risk contributors.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Asthma PDF
    Asthma PDF
    Asthma PDF
    Asthma PDF
    Asthma PDF

    Description

    Test your knowledge of asthma triggers and the inflammatory pathways involved in asthma. This quiz covers various factors such as tobacco smoke, dust mites, and more, exploring how they contribute to airway hyperresponsiveness. Enhance your understanding of asthma and its management.

    Use Quizgecko on...
    Browser
    Browser