Asthma and Cystic Fibrosis Flashcards
Obstructive disease
air gets trapped in lungs
Nonseptic obstructive diseases
- less sputum
- emphysema, asthma, chronic bronchitis
Septic obstructive diseases
- lots of sputum
- CF, bronchiectasis
Restrictive disease
- loss of lung compliance and chest wall expansion
- decreased depth and increased rate of breathing
What is asthma?
reversible obstruction to airflow within the lungs
Risk factors of asthma?
- childhood asthma
- family history
- atopy (allergic hypersensitivity)
- maternal smoking
- occupation/environmental exposures
- secondary smoke
- gender (women more likely)
Associations of asthma
- increased in families with asthma or allergies
- 1 parent: 1/3 chance
- 2 parents: 7/10 chance
Signs and symptoms of asthma
- wheezing: high pitched whistling sounds when breathing out
- cough, chest tightness, difficulty breathing
Symptoms may occur/worsen with what?
- exercise
- infection
- animals/allergies
- smoke
Pathophysiology of asthma
- intermediate type hypersensitivity reaction
- mast cells release histamine
- cells of immune system stimulate airway
- airway inflammation –> intermittent airflow obstruction –> bronchial hyper-responsiveness
Diagnosis of asthma (FEV1 and FEV1/FVC percentages)
Airway obstruction is episodic AND reversible
– Airway obstruction: FEV1 12% and 200 ml after short acting beta-2 agonist
Classification of severity of asthma: Severe persistent
- Days with symptoms – continuous
- Nights with symptoms – frequent
- PEF or FEV1 30%
Classification of severity of asthma: Moderate persistent
- Days with symptoms – daily
- Nights with symptoms > or = 5/month
- PEF or FEV1 > 60% and 30%
Classification of severity of asthma: Mild persistent
- Days with symptoms – 3-6/week
- Nights with symptoms – 3-4/month
- PEF or FEV1 > or = 80%
- PEF variability = 20-30%
Classification of severity of asthma: Mild intermittent
- Days with symptoms or = 80%
- PEF variability
Common medications used to treat asthma (4)
a. Albuterol (B2 selective bronchodilator)
b. Atrovent (anticholinergic, prevents bronchoconstriction)
c. Salmeteral (Serovent; B2 bronchodilator)
d. Inhaled steroids (advair, flovent, symbicort)
Persistent asthmas needs 2-step process….what is it?
- long-term control
- - steroids, leukotriene agonists
- - long acting beta agonist - acute exacerbations
- - albuterol or short acting beta agonist
Asthma treatment goals
- minimal symptoms day or night
- near normal pulmonary function
- no limitations on activity
- aggressive treatment at first sign of worsening
- minimal or no exacerbations
- minimal albuterol use
- minimal or no adverse effects of medications
Consequences of asthma
- comorbities (obesity, sinusitis, GERD, sleep apnea)
- hyperexpansion of thorax
- postural changes
- decreased physical fitness/ restricted physical activity
- increased hospitalization
Exercise induced asthma
a. Airway drying –> hyperemia (increased blood flow) –> increased permeability –> swelling
b. Airway cooling –> hyperemia –> re-heat airway –> swelling
Incidence of exercise induced asthma occurring normally and in cold weather?
- Normally: 3-10%
- Cold weather: 35-50%
Treatment for exercise induced asthma
- Pre-treat with B-agonist before exercise
- early and longer warm up
- short exertion periods
What is cystic fibrosis?
cogenital disease of exocrine glands (genetic – must inherit a gene from each parent)
What is the gene for cystic fibrosis and what does it do?
CF Transmembrane Regulator (CFTR) Gene
a. Normally opens channel thru plasma membrane to allow chloride to pass thru
Defect of CFTR gene in people with cystic fibrosis?
Defect = faulty movement of Na+ and Cl-
– Too much NaCl pulled into cells, leaving behind dry mucus in airways –> increased bacterial infection
Consequences of cystic fibrosis
- mucus build up in airways –> severe lung infections
- Hypoxemia (low O2 in blood)
- Intestinal blockages (water and salt stay in cells)
- Pancreatic enzymes do not cross cell membrane
- Reproductive blockages
Common infections of cystic fibrosis
staphylococcus aureus, pseudomonas aeruginosa
- transmitted by respiratory or hand contact
- usually colonize in lungs and difficult to eradicate
Bronchiectasis
multiple infections in tubules of lungs = dilation/chronic stretching of bronchial walls
Treatment of pulmonary infections from cystic fibrosis
- beta-agonist inhaled bronchodilator
- mucolytics – thins mucus (pulmozyme, guaifenesin)
- airway clearance (autogenic drainage, active cycle breathing, percussion)
- antibiotics (aminoglycosides, inhaled Tobramycin, azithromycin)
Rheumatoid diseases in patients with CF (3)
- Cystic fibrosis arthropathy
- Hypertrophic pulmonary osteoarthropathy
- Osteoporosis
