asthma and cystic fibrosis Flashcards
Prevelence of asthma
Blacks more than whites
Hispanics get it most, but black women die from it most
Asthma definition
combo of bronchial hyperresponsiveness and reversible expiratory airflow limitation
asthma significance
more ppl are getting it, but less ppl are dying
-women get it more aft puberty
Asthma triggers
-acute infection: reduced airway diameter and increased inflammation
-viral stuff
-cockroaches
-any other allergy stuff
-any other artificial irritants
smoking and asthma
faster decline in lung func
increased sensitivity to triggers
-more visits to HCP
-worse response to treatment
21% of ppl with asthma keep smoking
exercise induced asthma/bronchospasm
airway obstruction from changes to mucosa from hypervntilation, cooling/rewarming air, and capillary leak
drugs and food to avoid with asthma
aspirin and NSAIDs
salicylic acid
BETA ADRENERGIC BLOCKERS
ACE inhibitors
Sulfite preservatives (fruit, beer, wine, salad bars)
yellow dye no. 5
correlation bt asthma and GERD
-reflux can trigger bronchoconstriction and aspiration
-asthma meds might worsen GERD symptoms (Beta agonists relax LES)
Is asthma genetic?
yea
Early phase response of asthma
right after exposure
mast cells release inflammatory mediators
-causes vasodilation and increased capillary permeability; itching; smooth muscle spasms/airway narrowing; goblet cell mucus production
Late phase response of asthma
inflammation finally
only happens in 50% of patients
use corticosteroids to treat
Remodeling
changes in bronchial wall f/ chronic inflammation
-fibrosis, smooth muscle hypertrophy, mucus hypersecretion, angiogenesis
manifestations
obvi- wheezing coughing, SOB, chest tightness
hyperinflation and long expiration from air trapping in narrow airways
Acute attack= wheezing (just on expiration at first, but on inspiration and expiration if it gets worse)
weird fact ab wheezing
mild attack = loud wheezing
severe attack = wheezing w/ forced expiration or not at all
what happens to pH in asthma?
alkalotic at first, but then becomes acidotic as patient tires
asthma compilcations
pneumonia
tension pneumothorax
status asthmaticus
ARF
status asthmaticus
super acute asthma attack
-hypoxia, hypercapnia, ARF
-big emergency
progresses to hypotension, bradycardia, and resp/card arrest
bronchodilators and corticosteroids don’t help
treatment of mild asthma attack
inhaled bronchodilator and oral corticosteroids
-monitor VS
Presentation of severe asthma attack
scared (agitated if hypoxemic)
-tachycardia and tachypnea
-accessory muscles
-PEFR < 50%
treatment of severe asthma attack
give O2 (get PaO2 > 60 and get SaO2 > 93%)
-monitor PEFR, ABG, VS
-bronchodilators and corticosteroids
SILENT CHEST IS EMERGENCY! –> GET HCP
drugs for short term
Bronchodilators
-SABA (albuterol, lasts 4-8 hrs)
-Also inhaled anticholinergics (usually used w/ SABA)
Anti-inflammatory stuff
-IV corticosteroids
Drugs for long terms
Bronchodilators
-LABA
-methylxanthines
-anticholinergics
Antiinflammatory
-oral or inhaled corticosteroids
-leukotriene modifiers
-anti-IgE
Pros and cons of SABA
Pros
-stops mast cell’s inflammatory mediators
-can take b4 exercise
Cons
-if use too much, causes tremors, anxiety, tachycardia, palpitations, and nausea
-not long term
LABA
e.g. Salmeterol r formoterol
used with ICS
-every 12 hrs
-not for acute attacks
pros and cons of corticosteroids
Pros
-reduces bronchial hyperresponsiveness
-blocks late-phase respose
-stops inflammation
-good long term
Cons
-candidiasis
-hoarseness
-dry cough
***can get better w/ spacer and gargling
oral vs inhaled corticosteroids
oral: use 1-2 weeks for chronic asthma
ICS: use long term on fixed schedule –> takes 24 hrs to work
nonperscription combo drugs
OTC bronchodilators
-ephedrine and guaifenesin –> don’t use
*stimulate CV ad CNS
Inhaler types
MDI
DPI
Nebulizers
how much is too much inhaler?
no more than 2 canisters/month
DPI pros and cons
Pros
-breath activated
-less coordination needed
-no spacer
Cons
-low FEV = inadequate inspiration
-can’t find all meds as DPIs
-powder can clump
Nebulizers
turn meds into mist that’re given through face mask or mouth piece
-requires air compressor or O2 generator
goal for PEFR
80% of personal best
which organs does CF affect
lungs, pancreas/biliary duct, intestines
which chromosome is fucked up in CF?
7 –> CFTR
what essentially is CF?
inability to excrete NaCl –> excessive mucus formation –> clogged glands –> scarring –> organ failure
CF sweat
super salty
progression of CF in lungs
-start in lower regions, small airways –> move to bigger
-mucus becomes dry and tenacious
-cilia motility is decreased
-thick secretions in bronchioles cause scarring, air trapping, and hyperinflation
common complications of CF
chroninc airway infections –> MDR pneumonia develops
-chronic inflammation of airways
vasculature in CF
chronic hypoxia and arterial vasoconstriction leads to remodeling of blood vessels –> eventually pulmonary htn, enlarged arteries, and cor pulmonale
pancreas stuff in CF
gets clogged up
-can’t secrete stuff for digestion –> lose nutrients
-combo type 1+2 diabetes due to impaired exocrine func
GI stuff in CF
-liver enzymes go up –> cirrhosis
-gallstones, gerds, percreatitis
-portal hypertension
-DIOS = distal intestinal obstruction syndrome
how to diagnose babies with cf
messed up stools
resp issues
fam history
appearance and sex stuff with CF
prodruding abdomen, but emaciated extremeties
reproductie issues
diagnostic study for CF
sweat test with pilocarpine (over 60 is positive)
drugs to give CF ppl
bronchodilators
inhaled hypertonic saline (7%)
inhaled dornase alpha
***metiabolized way quicker in CF ppl than in normal ppl –> may need higher and longer doses
how to treat pseudomonas
tobramycin
how to deal with pneumothorax CF
-chest drainage
-possibly pleural sclerosis
-if hemoptysis, bronchial artery embolisation
CF acute care
CPT
O2
antibiotics
corticosteroids
adequate nutrition
exercise in CF
helpful for removing secretions, but kinda dangerous
-make sure to drink gatoade for fluid and electrolytes
