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Review Question - QID 106823

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QID 106823 (Type "106823" in App Search)
A 6-year-old boy is brought to the pediatrician by his foster father because he is concerned about the boy's health. He states that at seemingly random times he will have episodes of severe difficulty breathing and wheezing. Upon questioning, the pediatrician learns that these episodes do not appear to be associated with exercise, irritants, or infection. The pediatrician suspects the child has a type of asthma that is associated with eosinophils. In this type of asthma, what is released by the eosinophils to cause bronchial epithelial damage?

IL-5

20%

37/188

Major basic protein

60%

112/188

IgM

1%

2/188

IL-8

6%

12/188

Interferon-gamma

11%

21/188

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Major basic protein is released by eosinophils and causes bronchial epithelial damage in patients with atopic asthma.

Asthma is an inflammatory airway disease that causes reversible airway obstruction and bronchospasm. It is commonly treated with beta-agonists, corticosteroids, and anticholinergics. Atopic (extrinsic) asthma is a type of asthma which is characterized by paroxysmal breathlessness and wheezing in young patients. It is not related to aspirin ingestion, pulmonary infections, inhalation of irritants, exercise, or stress. Eosinophils, which are activated by IL-5, appear to play a major role in the pathophysiology of the disease. Major basic protein is released by eosinophils and causes the bronchial epithelial damage characteristic of atopic asthma.

Pollart et al. review the management of acute asthma exacerbations. They state that in the ambulatory and emergency department settings, the goals of treatment are correction of severe hypoxemia, rapid reversal of airflow obstruction, and reduction of the risk of relapse. Multiple doses of inhaled anticholinergic medication combined with beta2 agonists improve lung function and decrease hospitalization in school-age children with severe asthma exacerbations.

D'Amato et al. review the role of anti-IgE monoclonal antibody (omalizumab) in the treatment of atopic asthma and allergic respiratory diseases. They state IgE antibodies are crucial immune mediators of airway inflammation in allergic atopic asthma and IgE-mediated hypersensitivity reactions are the likely mechanisms of allergen-induced airway obstruction. Therapeutic anti-IgE antibodies able to reduce free IgE levels and to block the binding of IgE have been developed and shown to be efficacious in treating atopic asthma.

Incorrect:
Answer 1: While IL-5 does activate eosinophils and is thus involved in the pathophysiology of atopic asthma, it does not directly cause bronchial epithelial damage.
Answer 3: IgM is involved in mucosal defense and is not associated with atopic asthma.
Answer 4: IL-8 is the major chemotactic factor for neutrophils and is not associated with atopic asthma.
Answer 5: Interferon-gamma activated macrophages and Th1 cells. It is not associated with atopic asthma.

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