Pulmonology – Asthma exam
1. What is the MC chronic respiratory illness?: - Asthma
2. Who are hospitalization rates the highest among asthma patients?: - black persons
and children
3. Who are death rates highest among asthma patients?: - Black persons aged 15-24 years
4. What are triggers for asthma?: - cold or dry air
- dust
- pollen
- exercise or smoke trigger
- allergens
- viral infections
- chronic rhinosinusitis/post-nasal drip
- GERD
- aspiration
- stress
- exposure to combustion products (tobacco, methamphetamines, disease fuel)
- air pollution
- medications
,- occupational exposures
- hormonal changes (catamenial meaning menstrual cycles and pregnancy)
5. Are asthma symptoms reversible?: YES
6. What is asthma characterized by?: - episodic EXPIRATORY airway obstruction + HYPERresponsive-
ness
7. Who is asthma MC in?: MC in patients with other atopic disease (eczema or allergies)
8. Describe the pathophysiology of asthma?: 1. Trigger
2. Airway inflammation
3. Goblet cell hyperplasia and small airway mucus plugging
4. Constriction of airways
9. What are the 3 mechanisms that cause inflammation with asthma?: - eosinophils
- neutrophils
- lymphocytes (especially T cells)
10. How do all phenotypes of asthma manifest as?: - wheezing
- SOB to cough
,- chest tightness
- (+) variable airflow obstruction
11. Describe:
12. What is the MC type of T2-low asthma endotype?: Neutrophilic inflammation asthma, which
INCREASES neutrophil levels
13. What is pauci-granulocytic asthma characterized by?: - type of T2-low asthma endotype
- NON-inflammatory
- lacks tissue infiltration by inflammatory cells
- Normal eosinophils (<76%) levels
- Normal neutrophils (<3%) levels
14. What are common RFs for the T2-low asthma endotype?: - INCREASED BMI
- cigarette smoking/exposure
15. Is T2-low asthma endotype responsive to steroids?: - NO, as it is SEVERE asthma
16. What type of chronic infection is associated with T2-low asthma endotype?: -
Mycoplasma
17. Which immune cells drive epithelial inflammatory response with T2-low
, asthma endotype?: - ILC1s and ILC3s
18. Which interleukin is upregulated in obesity, causing overexpression?: -IL-1beta
19. Which immune cell is triggered by pollutants?: - ILC-3
20. What is T2-high asthma endotype characterized by?: - Eosinophilic airway infiltrate +
TH2-dependent cytokine overexpression
21. Which interleukins are responsible for T2-high asthma endotype?: IL-4
IL-5
IL-13
22. What is the role of IL-5?: - mediates eosinophil formation, recruitment, and survival
23. What is the role of IL-4/13?: - induces B cells to produce IgE
24. What is the role of IL-13?: - (+) airway hyperresponsiveness
- increased mucus secretion
- goblet cell metaplasia
1. What is the MC chronic respiratory illness?: - Asthma
2. Who are hospitalization rates the highest among asthma patients?: - black persons
and children
3. Who are death rates highest among asthma patients?: - Black persons aged 15-24 years
4. What are triggers for asthma?: - cold or dry air
- dust
- pollen
- exercise or smoke trigger
- allergens
- viral infections
- chronic rhinosinusitis/post-nasal drip
- GERD
- aspiration
- stress
- exposure to combustion products (tobacco, methamphetamines, disease fuel)
- air pollution
- medications
,- occupational exposures
- hormonal changes (catamenial meaning menstrual cycles and pregnancy)
5. Are asthma symptoms reversible?: YES
6. What is asthma characterized by?: - episodic EXPIRATORY airway obstruction + HYPERresponsive-
ness
7. Who is asthma MC in?: MC in patients with other atopic disease (eczema or allergies)
8. Describe the pathophysiology of asthma?: 1. Trigger
2. Airway inflammation
3. Goblet cell hyperplasia and small airway mucus plugging
4. Constriction of airways
9. What are the 3 mechanisms that cause inflammation with asthma?: - eosinophils
- neutrophils
- lymphocytes (especially T cells)
10. How do all phenotypes of asthma manifest as?: - wheezing
- SOB to cough
,- chest tightness
- (+) variable airflow obstruction
11. Describe:
12. What is the MC type of T2-low asthma endotype?: Neutrophilic inflammation asthma, which
INCREASES neutrophil levels
13. What is pauci-granulocytic asthma characterized by?: - type of T2-low asthma endotype
- NON-inflammatory
- lacks tissue infiltration by inflammatory cells
- Normal eosinophils (<76%) levels
- Normal neutrophils (<3%) levels
14. What are common RFs for the T2-low asthma endotype?: - INCREASED BMI
- cigarette smoking/exposure
15. Is T2-low asthma endotype responsive to steroids?: - NO, as it is SEVERE asthma
16. What type of chronic infection is associated with T2-low asthma endotype?: -
Mycoplasma
17. Which immune cells drive epithelial inflammatory response with T2-low
, asthma endotype?: - ILC1s and ILC3s
18. Which interleukin is upregulated in obesity, causing overexpression?: -IL-1beta
19. Which immune cell is triggered by pollutants?: - ILC-3
20. What is T2-high asthma endotype characterized by?: - Eosinophilic airway infiltrate +
TH2-dependent cytokine overexpression
21. Which interleukins are responsible for T2-high asthma endotype?: IL-4
IL-5
IL-13
22. What is the role of IL-5?: - mediates eosinophil formation, recruitment, and survival
23. What is the role of IL-4/13?: - induces B cells to produce IgE
24. What is the role of IL-13?: - (+) airway hyperresponsiveness
- increased mucus secretion
- goblet cell metaplasia
