Asthma: Definition, diagnosis, evaluation and management

Question 1

What are the two main categories of obstructive lung diseases?

Answer 1

• COPD
• Asthma

Question 2

Asthma is a … rather than a …

Answer 2

Asthma is a syndrome rather than a disease. It is a complex, multifactorial condition with different phenotypes that vary with age.

Question 3

Asthma arises from…

Answer 3

complex interaction between a genetic predisposition and environmental exposures. Note that there are many genes involved in asthma and there is no specific genetic testing in clinic.

Question 4

Asthma is…

Answer 4

a a chronic inflammatory disease of the airways.

Question 5

What are the 3 main characteristics of asthma?

Answer 5

People with asthma have variable degrees of airway obstruction, airway inflammation and bronchial hyper-responsiveness.

Question 6

What accounts for 90% of asthma costs?

Answer 6

Poor asthma control (60% of asthmatics)

Question 7

Asthma is a “barrier diease”. Explain.

Answer 7

Rhe epithelium is a “barrier” that covers the airways. People with asthma have an epithelium which reacts differently to a variety of factors than normal people, triggering an inflammatory response (it gets more inflamed due to cold, allergy, infections, oxidative stress).

Question 8

What is the role of interleukin 4,5 and 13 in asthma? Why are they important?

Answer 8

There are now important treatments targeting these interleukins.

Question 9

Which type of lymphocyte is steroid sensitive?

Answer 9

Th2: lymphocytes -

Question 10

Which pathway is not steroid sensitive?

Answer 10

?

Question 11

What happens to airways smooth muscle in asthma?

Answer 11

Hypertrophy and hyperplasia of smooth muscle, which leads to an excess in the layer of airway smooth muscle and excess bronchoconstriction (smaller radius of the airway, which increases resistance to airflow).

Question 12

Younger asthmatics are….
Older asthmatics…

Answer 12

Younger asthmatics respond better to steroid treatments than older people…?

Question 13

What are symptoms of asthma?

Answer 13

• recurrent episodes of wheezing
• troublesome cough, especially at night
• coughing or wheezing after exercise
• counghing, wheezing or chest tightness after exposiure to airborne allergens and pollutants
• prolonged cough or wheeze following a respiratory infections

Question 14

What factors trigger asthma (or worsen symptoms in people with asthma)?

Answer 14

• respiratory tract infections
• allergens
• pollutants
• medications
• physical factors
• physiological factors

Question 15

How do we score asthma?

Answer 15

Using an ACQ5 asthma control questionnaire

Question 16

How is asthma diagnosed and monitored?

Answer 16

• Hisotry and patterns of syptoms
• Symptom scoring (ACQ5 questionnaire)
• Measurement of lung function (spirometry)
• Measurement of inflamatory status of the airways
• FeNO

Question 17

How is FEV1 different in people with asthma?

Answer 17

Decreased with asthma (may increase or even return to normal with treatment)

Question 18

What criteria determine significant reversibility in airflow after bronchodilator administration?

Answer 18

1. Improvement of FEV1 of at least 12% and at least 200 mL within 30 minutes after administration of bronchodilator
2. Improvement i % predicted FEV1>or=10% after administration of bronchodilator

Question 19

How do you measure airway responsiveness?

Answer 19

Give a very small dose of methacholine which….

Question 20

What are the 5 items of the ACQ5 questionnaire?

Answer 20

1. Night awakenings
2. Severity of morning symptoms
3. Limitation of activity
4. Shortness of breath
5. Wheezing

Question 21

How does the ACQ5 questionnaire work?

Question 22

Airway inflammation can also be measured by doing sputum induction with hypertonic saline. How does this work?

Question 23

Airway inflammation can also be measured by measuring nitric oxide. How?

Answer 23

In patients without asthma: low FeNO
In patients with asthma: high FeNO

Question 24

What are the goals of long-term management in asthma?

Answer 24

• Achieve and maintain control of symptoms
• Maintain normal activity levels, including exercise
• Maintain pulmonary function as close to normal levels as possible
• Prevent asthma exacerbations
• Avoid adverse effects from asthma medications
• Prevent asthma mortality

Question 25

What is considered to constitute acceptable control of asthma in Canada?

Question 26

How can asthma be effectively controlled and managed?

Answer 26

Pharmacologically: Non-pharmacologically:

Question 27

What types of medications are used to treat asthma?

Answer 27

Rescue medications ('ols' and 'iums'): short-acting bronchodilator agents (SABA) Controller medications : long-acting bronchodilator (LABD) Inhaled corticosteroids (ICS) ('ides' and 'ones') ICS-LABA Combination therapy) ('one' combined with 'ol', 'ide' combined with 'ol')

Question 28

Review stepwise approach to treating asthma...

Question 29

What reduces the rate of mortality in asthma?

Answer 29

Asthma mortality rate is reduced with each additional cartridge of inhaled corticosteroids (ICS) during the preceding year. Asthma mortality rate is reduced during the 3 months following stopping the treatment.

Question 30

Reduction in asthma exacerbation with the use of ICS is often dose-dependent. What type of doses are more effective?

Answer 30

Higher ICS doses are more effective than lower doses.

Question 31

Asthma is difficult to treat in what % of asthmatic population?

Answer 31

5-10% of asthmatic population

Question 32

Asthma that is difficult to reat characteristics

Answer 32

- increased use of asthma medicaton - 15x ER use - 20x hospital admission - increased absenteeism

Question 33

Wat is associated with severe asthma and poor response to therapy?

Answer 33

female gender, obesity and smoking

Question 34

Why could asthma still remain uncontrolled despite high dose therapy?

Answer 34

- incorrect diagnosis - non-adherence to therapy - hidden allergens/sensitizers - severe sinus infections - hidden triggers (e.g. in workplace) - co-morbidities

Question 35

What are 2 treatments for severe asthma?

Answer 35

1. Prednisone 2. Monoclonal antibodies

Question 36

Why do physicians use prednisone as a last resort?

Answer 36

It has many dangerous side effects when used frequently or long duration: - weak bones - weak muscles - cataracts - glaucoma - diabetes

Question 37

What is one of the key goals of asthma doctors?

Answer 37

Keeping patients OFF oral steroids by ensuring they use their inhalers consistently and ?.