Please enable JavaScript.

Coggle requires JavaScript to display documents.

2.1: Wheezing and Breathlessness, Pet dog, Maternal asthma (brother also…

- - - - Dendritic cells activated
    - - Allergen expressed on MHCII complex
        
        DC presents allergen to naive CD4+ T-cell (also OX-40/OX-40L costimulatory signal)
        
        Th0 cell differentiates into Th2, also clonal expansion
        
        Th2 releases a range of cytokines
        
        IL4 + 13 - activates B-cell, causing differentiation to plasma cells and class-switching to stimulate IgE secretion
        
        IgE bind to FcεR1 on mast cells; cross-linkage and binding with antigen
        
        1 more item...
        
        TNFα, IL-8 and IL-6 recruit other immune cells
        
        IL5 and IL-3 recruit basophils and eosinophils
        
        Leukotrienes are released
        
        1 more item...
        
        IL-4, IL-5, IL-13 induce goblet cell hyperplasia
- - - - Preventers
        
        Inhaled corticosteroids
        
        Dual therapy (LAβA + ICS)
        
        Symbicort: formeterol + budesonide
        
        Seretide: Salmeterol + Fluticasone propionate
        
        Monotherapy (preventers)
        
        Fluticasone
        
        Budesonide
        
        Ciclesonide
        
        Beclomethasone
        
        Leukotriene receptor antagonist (mainly for children)
        
        Montelukast
        
        Phosphodiesterase inhibitors
        
        Non-selective
        
        Aminophylline
        
        Caffeine
        
        Theophyllines
        
        Selective
        
        Roflumilast mainly for COPD
        
        Cromones
        
        Cromoglycate
        
        Nedocromil
      - Relievers
        
        Beta agonists
        
        LAβAs (Long Acting Beta Agonists)
        
        Formeterol
        
        Salmeterol
        
        ultraLAβA (ultra Long Acting Beta Agonists) mostly for COPD
        
        Indacaterol
        
        Vilanterol
        
        SAβAs (Short Acting Beta Agonists)
        
        Fenoterol
        
        Salbutamol
        
        Antimuscarinics (mainly for COPD, not asthma)
        
        SAMAs
        
        Ipratropium
        
        LAMAs
        
        Tiotropium
      - For Acute Exacerbations
        
        Oral corticosteroids
        
        Short course, high dose OCS for acute exacerbations
        
        Prednisone/Prednisolone
        
        Adrenaline (for anaphylaxis)
      - For Allergies
        
        Antihistamines particularly for allergies
        
        Second generation (less sedating) antihistamines
        
        Fexofenadine
        
        Loratadine
        
        Cetirizine
        
        First generation (sedating) antihistamines
        
        Promethazine
        
        (Dex)chlorpheniramine
        
        Alpha1 agonists (oral decongestants)
        
        Pseudoephedrine
        
        Phenylephrine
    - - Reduced FEV1
      - Reduced FVC
        
        Reduced FEV1/FVC ratio (<80%)
      - Increased RV (from gas trapping)
        
        Increased FRC
    - - Rhinorrhoea - mucopurulent secretions
      - Injected and red tympanic membrane and pharynx
      - Bilateral expiratory wheeze
        
        Low SAO2 (<95%)
    - - Avoid triggers
      - Check puffer/spacer technique and drug adherence
- - - - G-s protein coupled receptor
        
        GTP binds to G-s protein, α subunit unbinds, activates adenylyl cyclase
        
        AC activates cyclic Adenosine Monophosphate (cAMP)
        
        cAMP activates PKA by phosphorylation
        
        Smooth muscle contraction inhibited, bronchodilation
        
        Antagonises bronchoconstriction
        
        1 more item...
- - - - Activation of secondary messengers: IP3 & DAG
        
        Increase cytosolic Ca2+
        
        Binds to calmodulin, interacts with myosin light chain kinase
        
        Smooth muscle contraction & bronchoconstriction
        
        Response is exacerbated by inflammatory mediators acting through the same pathway