Term
| In spiromtery, a normal value is ____ of expected. |
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Definition
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Term
| In spirometry, how do indications of obstructive and restrictive dysfunction differ? |
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Definition
| The percentage of obstructive decreases, where as in restrictive, FEV1 and FVC decline at the same rate, thus the percentage may change and even increase. |
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Term
| Peak Flow Meters are useful for evaluating ______ |
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Definition
| Asthma severity, progress & adjustments in tx of chronic asthma, worsening lung fxn, and peak flow variability |
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Term
| What is used to definitively diagnose asthma? |
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Definition
| Spirometry - Pulmonary function testing (PFT) |
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Term
| What are the major environmental factors that contribute to asthma? |
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Definition
| Airborne allergens and Viral Respiratory infections |
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Term
| What sort of disorder is asthma? |
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Definition
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Term
| Which cells are often linked to sudden onset, fatal asthma exacerbations; as well as with occupational asthma and smokers? |
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Definition
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Term
| Which cells are the lymphocytes of concern? |
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Definition
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Term
| IL 4-5, released by _____, are ______ |
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Definition
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Term
| Inhaled antigens activate_______ |
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Definition
| lymphocytes and mast cells |
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Term
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Definition
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Term
| Mast cells release what inflammatory mediators and cytokines? |
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Definition
| histamines, leukotrienes, IL 4-5, and GM-CSF (Granulocyte Macrophage-colony Stimulating Factor) |
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Term
| Exercise induced bronchospasm may activate _______ by _______ |
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Definition
| Mast cells, osmotic stimuli |
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Term
| Eosinophils release which mediators? |
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Definition
| Leukotriene and granule proteins |
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Term
| What prolongs the lifespan of Eosinophils? |
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Definition
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Term
| Eosinophils respond to ____ |
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Definition
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Term
| _____are increased in severe asthma, acute exacerbations and smokers. Their role is_______ |
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Definition
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Term
| Epithelial cells are activated by ______ |
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Definition
| IgE dependent mechanisms, or precipitating virii, pollutants or histamine |
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Term
| Epithelial cell inflammation contributes to asthma by ______ |
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Definition
| increasing airway responsiveness, altering permeability of the airway mucosa, reducing epithelial-derived relaxant factors, and reducing proinflammatory degrading enzymes |
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Term
| What are the inflammatory mediators? |
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Definition
| Cytokines, leukotrienes, histamine and IgE |
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Term
| Which inflammatory mediator is likely to determine the severity and modify the inflammatory response? |
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Definition
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Term
| Which inflammatory mediator effect mucous secretion, airway edema, microvascular permeability and bronchoconstriction? |
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Definition
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Term
| Which inflammatory mediator contributes smooth muslce constriction and bronchospasm? |
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Definition
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Term
| Which inflammatory mediator is responsible for the activations of allergic reactions? |
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Definition
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Term
| What activates IgE? IgE activates which cells? What is the result? |
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Definition
Allergens activate IgE.
Lymphocytes, eosinophils and mast cells are activated by IgE.
The result is further release of inflammatory mediators by these activated cells |
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Term
| Persistent inflammation leads to edema. The structural changes resulting from airway edema are _____ |
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Definition
| airway remodeling, leading to less elastic airways. |
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Term
| The degree of hypperresponsiveness is determined by _____ |
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Definition
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Term
| Affected tissues during airway remodeling involve the Subbasement membrane, the subepithelium, smooth muscle, blood vessels, and mucous glands. How are each affected? |
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Definition
Sub basement membrane thickens
subepithelium fibrosis
smooth muscle hypertrophy and hyperplasia
BV proliferation and dilation
Mucous glands hyperplasia and hypersecretion |
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Term
| early phase inflammation of asthma is initiated by ____ and activates_____. It takes place over a matter |
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Definition
| initiated by IgE. Activates Mast Cells. Takes place over minutes. |
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Term
| Late phase inflammation occurs ___after initial provocation and can last up to ____. Cells activated include______. In addition to secretion, ______ takes place during this period. |
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Definition
| occurs 6-9 hours after initial provocation and can last up to 24 hrs. Cells activated are eosinophils, T-cells, basophils, neutrophils, and macrophages. Edema and hypersecretion takes place as well |
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Term
| During the chronic inflammatory phase of inflammation, ______airways are inflamed. The process of _____ is initiated by ______ |
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Definition
central and peripheral airways are inflamed
remodeling is initiated by cytokines and growth factors |
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Term
IL-2 and INF gamma are produced by ___ and are ____
IL-4,5,6,9,13 are _____ produced by ____ |
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Definition
cellular defense mechanisms, from Th1
Allergic mechanism cytokines from Th2 |
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Term
| ______are factors that enhance Th1 over Th2 |
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Definition
| Infection with mycobacterium tuberculosis, measles and Hep A; exposure to other kids, LESS FREQUENT use of abx. |
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Term
| Majore enivironmental factors contributing to asthma are ______ |
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Definition
| airborne allergens and respiratory viruses incl rhinovirus, respiratory syncytial virus and influenza |
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Term
| What are the more unusual environmental factors that can contribute to asthma? |
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Definition
| Food additives/preservatives, Stress, GERD, Medications (ASA, NSAIDs, BBs), PMS |
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Term
| Classic asthma symptoms are____ |
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Definition
| episodic dyspnea, wheezing, chest tightness, SoB, coughing (esp nocturnal), and difficulty breathing |
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Term
| in the physical exam of asthma, the pulse may be____ |
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Definition
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Term
| during the PE to diagnose asthma, breath sounds may be_____ |
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Definition
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Term
| During the PE exam of asthma, what characteristics may be seen in the shoulder, muscle use and chest? |
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Definition
| shoulders hunched, use of accessory muscles, deformed chest (due to trapped air) |
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Term
| In diagnosing asthma, FEV1 will be_____ relative to predicted limit |
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Definition
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Term
| In diagnosing asthma, FEV1/FVC will be_____ of the normal lower limit |
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Definition
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Term
| Peak flow is for (management/diagnosis/both) |
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Definition
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Term
| Asthma may be diagnosed if FEV1 increases by _____ after a administration of _____ or a short course of _____ |
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Definition
| >12%; SABA or ORAL ccs (2-3wks) |
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Term
| What is the key to determining obstructive vs restrictive disease? |
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Definition
| An FEV1/FVC of ≤65% of normal lower limit |
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