Asthma and Chronic Bronchitis Flashcards
ASTHMA is
Episodic in nature
Acute episodes alternate with symptom free periods
Chronic inflammatory disease
Airways narrow in response to a stimulus
What occurs during an Acute Attack
↑ mucosal edema
↑ secretions,
hyperactive airways (bronchospasm)
Loud audible wheezes, rales and rhonchi
Can asthma be life threatening
Yes!
Status Asthmaticus: severe asthmatic attack that does not respond adequately to usual therapy and may require hospitalization
Acute asthma attack episodes can be triggered by
Allergens
Infection
Environmental Stress (esp cold)
Emotional Stress
EXERCISE
Exercise Induced Bronchospasm is defined as
EIB (exercise induced bronchospasm) is defined as transitory constriction of the lower airways following strenuous exercise
Exercise Induced Bronchospasm is caused by
Caused by loss of heat and water from the lungs during exercise due to hyperventilation of dry cool air
*How is EIB managed
Pre-exercise warm up
Avoidance of environmental triggers (including cold)
Pharmacology (adherence)
Diet: sodium restriction and hydration, fish oil supplements (anti-inflammatory), Vitamin C (thought to ↓ oxidative damage but evidence is weak)
Preventing SOB is better than managing SOB
Asthma Meds - Quick relief (rescue) medications
relievers
Short acting beta agonists
– Commonly albuterol
Anticholinergics (Ipratropium) (blocks acetylcholine, more often rx for COPD than asthma)
Oral corticosteroids (for severe attacks (prednisone) )
Asthma Meds - Long term asthma control medications
preventors
Inhaled corticosteroids
Long acting beta agonists (LABAs)
Theophylline (taken in pill form)
Leukotriene modifiers (↓ immune response)
Combination drugs (corticosteroids + LABAs)
How are bronchodilators delivered
via Metered Dose Inhalers (MDIs)
As a therapist you should advocate pts with asthma
warm up and cool down
chest wall stretching - so chest can expand
pacing of activities
energy conservation
proper hydration - can be from dryness
avoidance of triggers (smoke, dust mites, pollution, pets (dander), mold, cold)
reinforce use of meds
Can you outgrow asthma
no, it just goes into remission
What is Bronchial Thermoplasty
procedure to help asthma where lungs are heated up
What is bronchitis (what happens to the lungs)
Hypertrophy of the mucous glands and increase in goblet cells
Loss of ciliary action
Thickening of bronchial wall
Obstruction
inflammation
Inc. secretions
Thick, tenacious, mucopurulent secretions
Chronic Bronchitis breath sounds
Prolonged phase of expiration
Coarse rales, rhonchi, and wheezes
pts with chronic bronchitis present
Chronic productive cough with morning expectoration Sputum: clear, mucoid, may be purulent Recurrent chest infections Overweight, cyanotic (CO2 retention) LE edema, R sided ♥ failure BLUE BLOATERS
Role of PT for pts with chronic bronchitis
Advocate for smoking cessation, infection prevention and proper hydration
You can provide education about airway clearance techniques
What are Bronchiectasis
Permanent abnormal dilation and distortion of bronchi caused by destruction of the elastic and muscular components of the bronchial walls
Describes an anatomic abnormality NOT
a single disease
seen in CF and chronic bronchitis
Bronchiectasis are Commonly caused by:
Necrotizing infections of the trachea and bronchial tubes
Necrotizing PNA (remember, recurrent infections are typically seen in chronic bronchitis and CF)
TB
Pertussis (whooping cough and vaccine has short term life)
Decreased incidence with vaccinations for pertussis, and use of antibiotics (Pertussis is resurgent, new guidelines recommend reimmunization of whole family expecting birth)
Chronic gastroesophageal reflux with aspiration
Foreign body aspiration
Lung diseases that upset the pressure balance that keeps the lungs open
Sarcoidosis
Interstitial Fibrosis
TB
Smoke or other inhalation injury
Immotile cilia syndrome
Bronchiectasis: Clinical Features
Patients will present with: Cough, copious mucopurulent sputum, fetid breath (bad breath), recurrent pulmonary infections
Frequently seen in conjunction with:
Cystic Fibrosis
Immotile Cilia Syndrome
Kartagener’s Syndrome [which consists of bronchiectasis, sinusitis, situs inversus (heart on the right side)]
Bronchitis Signs
Purulent Sputum: separates into 3 layers upon standing
Upper: frothy, white or greenish/brown
Middle: thin mucoid
Lower: thick plugs
Clubbing
Bronchial Breath Sounds
