Asthma and Chronic Bronchitis

Question 1

ASTHMA is

Answer 1

Episodic in nature

Acute episodes alternate with symptom free periods

Chronic inflammatory disease

Airways narrow in response to a stimulus

Question 2

What occurs during an Acute Attack

Answer 2

↑ mucosal edema
↑ secretions,
hyperactive airways (bronchospasm)
Loud audible wheezes, rales and rhonchi

Question 3

Can asthma be life threatening

Answer 3

Yes!

Status Asthmaticus: severe asthmatic attack that does not respond adequately to usual therapy and may require hospitalization

Question 4

Acute asthma attack episodes can be triggered by

Answer 4

Allergens
Infection
Environmental Stress (esp cold)
Emotional Stress

EXERCISE

Question 5

Exercise Induced Bronchospasm is defined as

Answer 5

EIB (exercise induced bronchospasm) is defined as transitory constriction of the lower airways following strenuous exercise

Question 6

Exercise Induced Bronchospasm is caused by

Answer 6

Caused by loss of heat and water from the lungs during exercise due to hyperventilation of dry cool air

Question 7

*How is EIB managed

Answer 7

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

Question 8

Asthma Meds - Quick relief (rescue) medications

relievers

Answer 8

Short acting beta agonists
– Commonly albuterol

Anticholinergics (Ipratropium) (blocks acetylcholine, more often rx for COPD than asthma)

Oral corticosteroids (for severe attacks
(prednisone) )

Question 9

Asthma Meds - Long term asthma control medications

preventors

Answer 9

Inhaled corticosteroids
Long acting beta agonists (LABAs)

Theophylline (taken in pill form)

Leukotriene modifiers (↓ immune response)

Combination drugs (corticosteroids + LABAs)

Question 10

How are bronchodilators delivered

Answer 10

via Metered Dose Inhalers (MDIs)

Question 11

As a therapist you should advocate pts with asthma

Answer 11

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

Question 12

Can you outgrow asthma

Answer 12

no, it just goes into remission

Question 13

What is Bronchial Thermoplasty

Answer 13

procedure to help asthma where lungs are heated up

Question 14

What is bronchitis (what happens to the lungs)

Answer 14

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

Question 15

Chronic Bronchitis breath sounds

Answer 15

Prolonged phase of expiration

Coarse rales, rhonchi, and wheezes

Question 16

pts with chronic bronchitis present

Answer 16

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

Question 17

Role of PT for pts with chronic bronchitis

Answer 17

Advocate for smoking cessation, infection prevention and proper hydration

You can provide education about airway clearance techniques

Question 18

What are Bronchiectasis

Answer 18

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

Question 19

Bronchiectasis are Commonly caused by:

Answer 19

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

Question 20

Bronchiectasis: Clinical Features

Answer 20

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)]

Question 21

Bronchitis Signs

Answer 21

Purulent Sputum: separates into 3 layers upon standing
Upper: frothy, white or greenish/brown
Middle: thin mucoid
Lower: thick plugs

Clubbing

Bronchial Breath Sounds