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Medicine

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Respiratory

Question
5 out of 13
 

The most predictive and dangerous side effect of propranolol that makes it to be avoided in known patient of COPD is induction of: (AIIMS Nov 10)



A Respiratory failure
B Acute asthmatic attack

C Glaucoma
D Pleural effusion

Ans. B

Acute asthmatic attack

Precipitants:

1). Cold air, exercise, emotion, allergens (house dust mite, pollen, animal fur), infection, drugs (eg aspirin, NSAIDs, beta blockers).

2). Diurnal variation in symptoms or peak flow. Marked morning dipping of peak flow is common and can dip the balance into a serious attack, despite having normal peak flow at other times.

4). Exercise: Quantify the exercise tolerance.

5. Acid reflux: This has a known association with asthma.

6. Other atopic disease: Eczema, hay fever, allergy, or family history

7. Recent Advances: Vitamin D deficiency may also predispose to the development of asthma

Extra Edge: Aspirin associated asthma usually begins with perennial vasomotor rhinitis that is followed by a hyperplastic rhinosinusitis with nasal polyps.

Pathogenesis

1). State of persistent subacute inflammation of the large and small airways.

2). Cells - Mast cells, eosinophils, lymphocytes & epithelial cells.

3). Mediators - Histamine, bradykinin, Leukotrines, D,E, PG E2, F2α, D2 & PAF, IL - 3, IL - 4, IL - 13).

4). Response - Bronchoconstriction, vascular congestion, edema formation, increase mucus production & impaired mucociliary function.

Pathology

The most striking pathological feature in bronchial asthma is bronchial inflammation & occlusion of bronchi and bronchioles (both large & small airway) by thick tenacious mucus plugs.

Features of Asthma:

1). Chronic inflammatory disorder

2). Hyperresponsiveness of airways (AHR)

3). Airway epithelial shedding

4). Subepithelial fibrosis and thickening of basement membrane

5). Hypertrophy and Hyperplasia of airway smooth muscle

6). Microvascular leakage resulting in airway edema and plasma exudation into airway lumen

7). Mucus Hypersecretion and formation of viscid mucus plugs that occlude airways

8). Defects in autonomic neural control

Respiratory Flashcard List

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