Term
| ashtma is clinically characterized by |
|
Definition
| recurrent bouts of shortness of breath, chest tighness and wheezing, often associated with coughing |
|
|
Term
| short-term asthma reflief is most effectively achieved by |
|
Definition
| agents that relax airway smooth muscle (B-adrenoreceptor stimulants) |
|
|
Term
| asthma is physiologically characterized by |
|
Definition
| widespread, reversible narrowing of the bronchial airway and a marked increase in bronchial responsiveness to inhaled stimuli |
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|
Term
| asthma is pathologically characterized by |
|
Definition
| lymphocytic, eosinophilic, inflammation of the bronchial mucosa |
|
|
Term
| airway obstruction and contraction of smooth muscle |
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Definition
| most easily reversed consequence of asthma by current therapy |
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Term
| reversal of edema and cellular infiltration requires |
|
Definition
| sustained treatment with anti-inflammatory agents |
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|
Term
| long-term asthma control is |
|
Definition
| most effectively achieved with an anti-inflammatory agent such as an inhaled corticosteroid |
|
|
Term
| long-term asthma control can be achieved (albeit less effectively than an inhled corticosteroid) with |
|
Definition
| a leukotriene pathway antagonist or an inhibitor of mast cell degranulation (Cromolyn or nedocromil) |
|
|
Term
| foreign materials that provoke IgE production |
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Definition
|
|
Term
| histamine, tryptase, leukotrienes C4 and D4 and prostaglandin D2 |
|
Definition
| diffuse through the airway mucosa, triggering the muscle constriction and vascular leakage responsible for the acute bronchoconstriction of the "early" asthma response |
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|
Term
|
Definition
| sustained phase of bronchoconstriction, is associated with an influx of inflammatory cells into the bronchial mucosa and with an increase in bronchial reactivity that may last for several weeks |
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|
Term
| mediators responsibe for late phase reaction |
|
Definition
| cytokines of TH2 cells (IL 5, 9, 13). |
|
|
Term
| IL-5, 9, 13 (late phase TH2) |
|
Definition
| attrat and activate eosinophils, stimulate IgE production by -lymphocytes and stimulate mucus production by bronchial epithelial cells |
|
|
Term
| benefits of corticosteroid therapy for asthma are attributed to |
|
Definition
| their inhibition of the production of pro-inflammatory cytokines in the airways |
|
|
Term
| most asthma attacks are not triggered by inhalation of allergens but by |
|
Definition
| viral respiratory infections |
|
|
Term
| bronchial reactivity is assessed by |
|
Definition
| measuring the fall in forced expiratory volume in 1 scond (FEV1) provoked by inhaling serially increased concentrations of aerosolized methacholine |
|
|
Term
| bronchospasm can b provoked by nonallergenci stimuli such as |
|
Definition
| distilled water, exercise, cold air, sulfur dioxide, and rapid respiratory maneuvers |
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|
Term
|
Definition
| prevnent mast cell degranulation |
|
|
Term
|
Definition
| inhibit the effect of acetylcholine |
|
|
Term
|
Definition
| relax airway smooth muscle and inhibit release of bronchoconstricting mediators from mast cells |
|
|
Term
| sympathomimetic agents such as theophylline |
|
Definition
| directly relax airway smooth muscle |
|
|
Term
| management of early, acute asthma is best/most often achieved by |
|
Definition
| adrenoreceptor agonists, or sympathomimetic agents (relievers, bronchodilators) |
|
|
Term
| B-agonists activate adenylyl cyclase via |
|
Definition
| the coupling protein Gs and increase the fomration of intracellular cAMP |
|
|
Term
| (in general) stimulation of B2 receptors |
|
Definition
| relaxes airway smooth muscle, inhibits mediator release and causes tachycardia and skeletal muscle tremor (as adverse effects) |
|
|
Term
| epinephrine and isoproterenol |
|
Definition
| increase the force of cardiac contraction (mediated mainly by B1 receptors) and are thus reserved for special situations |
|
|
Term
| (in general) adrenoreceptor agonists are best delivered by inhalation because |
|
Definition
| this results in the greatest local effect on airway smooth muscle with the least systemic toxicity |
|
|
Term
| bronchial deposition of an aerosol is increased by |
|
Definition
| slow inhalation of nearly a full breath and by more than 5 seconds of breath holding at the end of inspiration |
|
|
Term
| because epinephrine stimulates alpha and B1 as well as B2 receptors |
|
Definition
| tachycardia, arrythmias and worsening of angina pectoris are troublesome adverse effects |
|
|
Term
| the cardiovascular effects of epinephrine and of value for treating |
|
Definition
| the acute vasodilation and shock as well as the bronchospasm of anaphylaxis, but its use in asthma has been displaced by other, more B2 selective agents |
|
|
Term
| new generation of long-acting B2 selective agonists include |
|
Definition
| salmeterol and formoterol (both drugs are poent B2 agonists that achieve their long duration of action (12 hours of more) as a result of high lipid solubility |
|
|
Term
|
Definition
| B2 selective adrenoreceptor agonists (most widely used sympathomimetic for treatment of the bronchoconstriction of asthma at present) |
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|
Term
| particles generated by a nebulizer |
|
Definition
| are much larger than those from a MDI |
|
|
Term
| nebulized therapy should be reserved for |
|
Definition
| patients unable to coordinate inhalation from a MDI |
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|
Term
|
Definition
| can be shown to inhibit several members of the phosphodiesterase (PDE) enzyme family |
|
|
Term
|
Definition
| hydrolyzes cyclic nucleotides |
|
|
Term
| phosphodiesterase inhibition |
|
Definition
| results in higher concentrations of intracellular cAMP, and in some tissues cGMP |
|
|
Term
|
Definition
| appears to be most directly involved in actions of methylxanthines on airway smooth muscle (and on inflammatory cells) |
|
|
Term
|
Definition
| potent competitive inhibitor of acetylcholine at postganglionic muscarinic receptors as a bronchodilator |
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|
Term
| IV atropine causes bronchodilation at |
|
Definition
| a lower dose than that needed cause an increase in heart rate |
|
|
Term
| muscarinic antagonists competively inhibit |
|
Definition
| the effect of acetylcholine at muscarinic receptors |
|
|
Term
| in the airways, ACh is released from |
|
Definition
| efferent endings of the vagus nerves |
|
|
Term
|
Definition
| block the contraction of airway smooth muscle and the increase secretion of mucus that occurs in response to vagal activity |
|
|
Term
|
Definition
| non-selective quaternary ammoium derivative of atropine |
|
|
Term
| although antimuscarinic drugs appear to be slightly less effective than B-agonists in reversing asthmatic bronchospasm |
|
Definition
| the addition of ipratropium enhances the bronchodilation produced by nebulied albuterol in acute severe asthma |
|
|
Term
|
Definition
| their broad anti-inflammatory efficacy mediated in part by inhibition of production of inflammatory cytokines |
|
|
Term
| corticosteroids do not relax airway smooth muscle directly but |
|
Definition
| reduce bronchial reactivity and reduce the frequency of asthma exacerbations if taken regularly |
|
|
Term
| regular or "controller" therapy is maintained with |
|
Definition
|
|
Term
| urgent treatment is often begun with |
|
Definition
| an oral dose of 30-60mg prednisone per day or an IV dose of 1mg/kg methylprednisone every 6 hours (daily dose is decreased after airway obstruction has improved) |
|
|
Term
| customary to administer corticosteroids |
|
Definition
| early in the morning after endogenous ACTH secretion has peaked |
|
|
Term
| in children, inhaled corticosteroid therapy |
|
Definition
| has been shown to slow the rate of growth but this effect appears to be transient (asthma itself delays puberty) |
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|
Term
| cromolyn and nedocromil have no effect on |
|
Definition
| airway smooth muscle tone and are ineffective in reversing asthamtic bronchospasm (prophylactic) |
|
|
Term
|
Definition
| inhibt mast cell degranulation by altering the function of delayed chloride channels in the cell membrane, inhibiting cell activation |
|
|
Term
| when taken regularly (2-4 puffs 2-4 times a day) by patients with perennial (non-seasonal) asthma both cromolyn and nedocromil |
|
Definition
| reduce symptomatic severity and the need for bronchodilator medications |
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|
Term
|
Definition
| the action of 5-lipoxygenase on arachidonic acid and are synthesized by a variety of inflamatory cells in the airways (mast cells, eosinophils, basophils) |
|
|
Term
| inhalation (study) of leukotrienes causes |
|
Definition
| bronchoconstriction and also an increase in bronchial reactivity to histamine, that lasts for several days |
|
|
Term
|
Definition
|
|
Term
| zafirlukast and montelukast |
|
Definition
|
|
Term
| inhibiting 5-lipoxygenase |
|
Definition
| prevents leukotriene synthesis |
|
|
Term
| inhibiting binding of LTD4 to its receptor on target tissues |
|
Definition
|
|
Term
| principal advantage of leukotriene pathway inhibitors |
|
Definition
| is that they are taken orally, seeing as how some patients, especially children, comply poorly with inhaled therapies |
|
|
Term
|
Definition
| anti-IgE monoclonal antibody |
|
|
Term
|
Definition
| treatment with a long term controller like an inhaled corticosteroid is necessary to prevent symptoms and restore function |
|
|
Term
| the use of 2 or more canisters of an inhaled B-agonist per month is a marker of |
|
Definition
| increased risk of asthma fatality |
|
|
Term
|
Definition
| occasional inhalation of a bronchodilator may be all this is needed |
|
|
Term
| if FEV1 is less than 80% predicted |
|
Definition
| additional treatment is needed |
|
|
Term
| if patient requires "rescue" therapy more than twice a week, if nocturnal symptoms occur more than twice a month |
|
Definition
| additional treatment is needed |
|
|
Term
| first "additional" treatment |
|
Definition
| lose doese of an inhaled corticosteroid, althogh treatment with a leukotriene-receptor antagonist or with cromolyn may be used |
|
|
Term
|
Definition
| take up to 4 puffs of albuterol every 20 minutes over 1 hour, if clear improvment is not noted after 1st 4 puffs, additional treatments should be taken en route to the ER |
|
|
Term
| antimuscarinics (muscarinic antagonists) |
|
Definition
| help inhibit the increase in mucus secretion caused by vagal stimulation |
|
|
Term
| if asthma symptoms occur frequently or if airway obstruction persists depsite bronchodilator therapy |
|
Definition
| inhaled corticosteroids should be started |
|
|
Term
| for patients with severe symptoms of airflow obstruction (FEV1 <50% predicted) |
|
Definition
| initial treatment with a combination of inhaled and oral corticosteroids (eg 30 mg prednisone for 3 weeks) is appropriate |
|
|
Term
| impressive benefits are noted from addition of a long-acting inhaled B2 receptor agonist (salmetrol or formoterol) when |
|
Definition
| inhaled corticosteroids are not sufficient (other option besides combing with another drug is to double the inhaled corticosteroid dose) |
|
|
Term
| combinations or an inhaled corticosteroid and a long-acting B-agonist in a single inhaler are now commonly prescribed |
|
Definition
| fluticasone and salmeterol (Advair), budesonide and formoterol (Symbicort) |
|
|
Term
| cromolyn and nedocromil or inhaled leukotriene-receptor antagonists, all avoid |
|
Definition
| steroid phobia (although none are as effective as even a low dose of an inhaled corticosteroid) |
|
|
Term
|
Definition
| airflow limitation that is not fully reversible with bronchodilator treatment |
|
|
Term
| chronic treatment with oral corticosteroids |
|
Definition
| may cause osteroporosis, cataracts, glucose interolerance, worsening or HTN and cushingoid changes in appearance |
|
|
Term
|
Definition
| is often associated with neutrophils rather than eosinophilic inflammation, as is seen in asthma |
|
|
Term
| approaches to treatment are similar for asthma and COPD although |
|
Definition
| benefits expected (and achieved) are less for COPD than for asthma |
|
|
Term
| theophylline may improve contractile function |
|
Definition
| of the diaphragm in COPD patients |
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|
