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Asthma Pathophysiology and Treatment
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1
Question
What is bronchial asthma (BA)?
Page 1
Answer
A chronic inflammatory disease of the airways characterized by episodes of acute bronchoconstriction causing shortness of breath, cough, chest tightness, wheezing.
2
Question
What are the main components of airway obstruction in asthma pathophysiology?
Page 1
Answer
Bronchoconstriction + inflammation of mucosa → ↑ bronchial secretion → remodelling of bronchial wall (activation of fibroblasts & collagen deposition) + increase in bronchial responsiveness to inhaled stimuli.
3
Question
Name four common triggers of asthmatic attacks.
Page 2
Answer
• Allergens • Stress • Respiratory infections • Exercise
4
Question
List additional triggers of asthmatic attacks beyond allergens and stress.
Page 2
Answer
• Drugs • Air pollutants
5
Question
What is airway remodelling in asthma?
Page 4
Answer
Structural change caused by asthma that leads to thickened airway walls and narrowing of the airway.
6
Question
What are the clinical manifestations of asthma?
Page 4
Answer
• Dyspnea • Cough • Expectoration
7
Question
Identify three key pathological changes in asthmatic airways.
Page 5
Answer
• Bronchoconstriction • Inflammation, edema of bronchial mucosa • Increased secretion of mucus
8
Question
Which neurotransmitter causes bronchoconstriction via parasympathetic nerves?
Page 6
Answer
Acetylcholine
9
Question
Name four autacoids (local hormones) involved in bronchoconstriction.
Page 6
Answer
• Histamine • Bradykinins • Prostaglandins (Pg) • Leukotrienes
10
Question
What does FEV1 stand for in spirometry?
Page 7
Answer
Forced Expiratory Volume in 1 second: the maximal amount of air you can forcefully exhale in one second.
11
Question
How is FEV1 interpreted?
Page 7
Answer
Converted to a percentage of normal (predicted based on height, weight, and race).
12
Question
What does FEV1 greater than 80% of predicted indicate?
Page 8
Answer
Normal lung function.
13
Question
Classify the degree of obstruction when FEV1 is 60-79% of predicted.
Page 8
Answer
Mild obstruction.
14
Question
What obstruction severity corresponds to FEV1 40-59% of predicted?
Page 8
Answer
Moderate obstruction.
15
Question
FEV1 less than 40% of predicted signifies what level of obstruction?
Page 8
Answer
Severe obstruction.
16
Question
Name the three main groups of bronchodilators used for asthma control.
Page 8
Answer
• Beta2-adrenoceptor agonists (“relievers”) • M-cholinolytics • Methylxanthine drugs (phosphodiesterase inhibitors)
17
Question
Identify the two main groups of anti-inflammatory drugs for asthma.
Page 9
Answer
• Glucocorticosteroids (“controllers” or anti-inflammatory) • Inhibitors of mast cell degranulation
18
Question
What are the primary goals of asthma therapy?
Page 9
Answer
• Decrease the intensity & frequency of asthma attacks • Control bronchial obstruction • Control chronic bronchial inflammation
19
Question
Where are beta-receptors abundant in the respiratory system?
Page 10
Answer
On airway smooth muscle cells.
20
Question
What is the first step in beta-agonist mode of action after binding to beta-receptor?
Page 11
Answer
Dissociation of the alpha-subunit of the G protein, bound to GTP.
21
Question
How do beta-agonists increase cAMP levels?
Page 11
Answer
Alpha-subunit activates adenylyl cyclase (AC) and ↑ synthesis of cAMP.
22
Question
What does increased cAMP activate in airway smooth muscle?
Page 11
Answer
A protein-kinase which activates other cellular enzymes.
23
Question
How do beta2-agonists inhibit myosin light-chain kinase (MLCK)?
Page 11
Answer
cAMP activates protein kinase → phosphorylates MLCK → inactivates it.
24
Question
What is the primary therapeutic effect of beta-agonists in asthma?
Page 12
Answer
Relax airway smooth muscle & eliminate bronchoconstriction.
25
Question
Are beta-agonists effective during acute asthmatic attacks?
Page 13
Answer
Yes, highly effective!
26
Question
Do beta-agonists affect the chronic inflammatory process in asthma?
Page 13
Answer
No effect.
27
Question
Why are beta2-selective agonists preferred over non-selective?
Page 13
Answer
Beta2-agonists are preferred!
28
Question
What is the advantage of inhaled beta2-adrenergic agonists?
Page 13
Answer
Rapid and reliable effect with minimum adverse drug reactions (ADRs).
29
Question
List three indications for beta2-agonists.
Page 13
Answer
• Bronchial asthma • Spastic bronchitis • Emphysema
30
Question
Name three cardiovascular ADRs of beta2-agonists.
Page 14
Answer
• Tachycardia • Arrhythmia • ↑ Blood pressure (BP)