Podcast
Questions and Answers
Which of the following is NOT commonly associated with asthma triggers?
Which of the following is NOT commonly associated with asthma triggers?
What symptom is commonly reported as worsening at night in asthma patients?
What symptom is commonly reported as worsening at night in asthma patients?
Which of the following indicates a positive response in asthma diagnosis when tested?
Which of the following indicates a positive response in asthma diagnosis when tested?
What is a common misconception about asthma medication?
What is a common misconception about asthma medication?
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Which of the following is a common objective measure used to diagnose asthma?
Which of the following is a common objective measure used to diagnose asthma?
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What is the primary goal of asthma therapy?
What is the primary goal of asthma therapy?
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Which of the following is a characteristic of the early asthmatic response?
Which of the following is a characteristic of the early asthmatic response?
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What are the potential risks of not treating asthma?
What are the potential risks of not treating asthma?
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What is a typical goal regarding peak flow rate variability in asthma therapy?
What is a typical goal regarding peak flow rate variability in asthma therapy?
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Which cytokines are predominantly involved in the late asthmatic response?
Which cytokines are predominantly involved in the late asthmatic response?
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What is a major factor in the heterogeneity of asthma?
What is a major factor in the heterogeneity of asthma?
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What can be a consequence of starting asthma treatment late?
What can be a consequence of starting asthma treatment late?
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What action is primarily prevented by bronchodilators in asthma management?
What action is primarily prevented by bronchodilators in asthma management?
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Which medication was primarily used for asthma therapy in the 1960s?
Which medication was primarily used for asthma therapy in the 1960s?
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What was a significant addition to asthma therapy in the 2000s?
What was a significant addition to asthma therapy in the 2000s?
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Which therapy was introduced for asthma care in the 1990s?
Which therapy was introduced for asthma care in the 1990s?
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Which class of medication is associated with quick relief for asthma patients?
Which class of medication is associated with quick relief for asthma patients?
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What combination was common in asthma therapy during the 2000s?
What combination was common in asthma therapy during the 2000s?
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In which decade did the use of Inhaled Corticosteroids become prevalent?
In which decade did the use of Inhaled Corticosteroids become prevalent?
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What was a major therapeutic advancement for asthma in the 2010s?
What was a major therapeutic advancement for asthma in the 2010s?
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Which medication class was not used in the 1970s asthma therapy?
Which medication class was not used in the 1970s asthma therapy?
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Study Notes
Bronchial Asthma Treatment
- Asthma is a chronic inflammatory disorder with intermittent airway narrowing. It's also characterized by wide variations in airflow resistance over short periods.
- Asthma treatment aims for normal function. However, the condition varies in cause, bronchoconstriction extent, and inflammation degree. This makes the treatment course unpredictable, requiring individualized therapy.
- Failure to treat asthma leads to poor or no control, accelerated lung function decline, increased asthma attacks, reduced response to treatment if started late, and increased mortality.
- Treatment goals include minimal symptoms (even during sleep), infrequent acute episodes, no missed school/work days due to asthma, rare need for beta-agonist inhalers, unrestricted activities (including sports), peak flow variability below 20%, and minimal drug side effects.
Asthma Pathogenesis
- Early Asthmatic Response: Allergens trigger IgE production, a genetically determined trait. Allergen re-exposure creates antigen-antibody interactions on mast cells, leading to stored mediator release. Activation of neural pathways also occurs, preventable by bronchodilators.
- Late Asthmatic Response (4-5 hours later): This phase involves sustained bronchoconstriction, increased inflammatory cell influx, and enhanced bronchial responsiveness. Cytokines (especially interleukins 5, 9, and 13) produced by TH2 lymphocytes drive IgE production and stimulate mucus production. This phase is managed with corticosteroids.
Risk Factors of Untreated Asthma
- Poor or lack of control of asthma
- Accelerated lung function decline
- Increased number of attacks
- Poorer treatment response if treatment is started late
- Increased mortality
Diagnosis of Asthma (Subjective)
- A persistent cough, often occurring in spasms, and worsening at night is common. A cough may follow exposure to irritants, like cold air or allergens.
- Shortness of breath (dyspnea) develops along with coughing and wheezing, followed by sputum production.
- Previous bronchiolitis history as a child is relevant.
- A family history of asthma is common.
Diagnosis of Asthma (Objective)
- Reduced peak expiratory flow rate (PEFR).
- Reduced forced expiratory flow rates (FEFR).
- Reversibility with bronchodilator use.
- Increased response to methacholine testing.
- Increased levels of exhaled nitric oxide.
- Elevated inflammatory mediators and their byproducts in bodily fluids.
Asthma Myths & Misconceptions
- Patient and physician "steroid-o-phobia."
- Asthma is not an emotional illness.
- Asthma is not an acute disease.
- Asthma medications are not typically addictive.
- Asthma medications generally do not lose effectiveness with regular use.
- Asthma is not usually a fatal illness.
Survey of Asthma Therapy Changes Over Decades
- 1960s: Aminophylline, Epinephrine, Ephedrine
- 1970s: Beta-agonists, Theophyllines, Beclomethasone, Cromolyn, Ipratropium
- 1980s: Beta-agonists, Inhaled corticosteroids, Cromolyn, Ipratropium
- 1990s: Inhaled corticosteroids, Beta-agonists, Theophylline, Leukotriene Inhibitors
- 2000s: Corticosteroids + LABA, LTRAs, Theophylline, Cromolyn, Ipratropium, Tiotropium
- 2010s: Prevention strategies, including gene therapy
Asthma Medications (Quick Relief)
- Inhaled short-acting beta-2 agonists
- Inhaled anticholinergics
- Systemic corticosteroids
Asthma Medications (Long-Term Control)
- Topical (inhaled) corticosteroids
- Inhaled cromolyn Na and nedocromil
- Methylxanthines (Theophyllines)
- Inhaled long-acting beta-2 agonists (LABAs)
- Oral leukotriene modifiers (LTRAs)
Asthma Triggers
- Exercise/cold air
- Cigarette smoke
- Stress/anxiety
- Animal dander (cats, dogs)
- Allergens (grass, trees, molds, cockroaches)
- Air pollutants (sulfur dioxide, ozone)
- Fumes/toxic substances
- Medications (ASA, NSAIDs)
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Description
This quiz covers essential aspects of bronchial asthma, including its treatment goals, pathogenesis, and the challenges in managing the condition. Learn about the early asthmatic response and the importance of individualized therapy to achieve optimal control and minimize symptoms.
