Asthma and OSA

Question 1

Summarize the pathophysiology of asthma (how is it stimulated, what happens to the smooth muscle, what is the result)

Answer 1

1. Allergen induced (IgE -> Mast cell release)
2. Obstructed airway from:
   - Too much mucus (plugs), inflammation, edema
   - Exaggerated bronchoconstriction
3. Permanent remodeling of smooth muscle and other cells that increases airflow obstruction and airway hyperresponsiveness

Question 2

Explain the role of airway edema in the pathophys of asthma

Answer 2

• As a result of the mast cell release, the airways become swollen (edema), inflamed, and mucus hyper secretion leads to formation of mucus plugs
• Smooth muscles hypertrophy and hyperplasia occurs

Question 3

Explain the role of bronchoconstriction in the pathophys of asthma

Answer 3

• Exaggerated response due to a wide variety of stimuli

- Due to inflammation

Question 4

Summarize the remodeling occurs in the airways with asthma?

Answer 4

• Permanent changes that increase airflow obstruction and airway hyper responsiveness
• Thickening of sub-basement membrane
• Sub-epithelial fibrosis
• Smooth muscle hypertrophy and hyperplasia
• Mucus gland hyperplasia and hypersecretion
• Put simply: the lining and muscle aren’t as stretchy and the muscles don’t dilate as well

Question 5

What is OSA

Answer 5

recurrent upper airway obstruction

Question 6

What are most common symptoms of OSA

Answer 6

snoring

excessive daytime sleepiness

Question 7

What are risk factors for OSA

Answer 7

obesity
craniofacial abnormalities
age
smoking
menopause
alcohol
medications

Question 8

What is the gold standard for dx of OSA

Answer 8

polysomnography (sleep study)

Question 9

What are the diagnostic criteria for OSA

Answer 9

5 or more obstructive events with risk factors present

OR

15 or more obstructive events with no risk factors present

AND

AHI > 5

Question 10

OSA txt

Answer 10

weight loss
sleep position
alcohol advoidance
CPAP
oral appliance
surgery

Question 11

Epidemiology of Asthma

Answer 11

Incidence is highest in children, but affects all ages and occurs world wide with a preponderance of the disease in developed industrialized countries.