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S2 MAP II > Asthma and Cystic Fibrosis > Flashcards

Asthma and Cystic Fibrosis Flashcards

1
Q

obstructive pulmonary disease

  • what happens
  • types
A

air get trapped in the lungs
types
-nonseptic obstructive diseases
-septic obstructive pulmonary diseases

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2
Q

nonseptic obstructive disease examples

A

emphysema
asthma
chronic bronchitis

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3
Q

septic obstructive pulmonary disease examples

A

cystic fibrosis

bronchiectasis

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4
Q

restrictive pulmonary disease

  • what happens
  • result…
A

loss of lung compliance and chest wall expansion

decreased depth and increased rate of breathing

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5
Q

asthma

-obstructive or restrictive

A

obstructive

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6
Q

asthma

  • characterized by…
  • risk factors
A 
characterized by REVERSIBLE obstruction to airflow within the lungs
risk factors
-childhood asthma
-family history
-atopy
-maternal smoking
-occupational exposure
-environmental exposures
-secondary smoke
-gender
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7
Q

asthma associations

  • increase in families with…
  • of children with asthma (what were associated conditions)
A

increased in families with asthma or allergies
of children with asthma
-77% had allergic rhinitis
-17% eczema
-91% family history of allergy in 1st degree relative

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8
Q

asthma

-US prevalence

A

most common chronic childhood disease
6.5 million under age 18 with ashtma
>4000 deaths/year
ethnic differences in asthma prevalence, morbidity and mortality are highly correlated with poverty, urban air quality, indoor allergens, and lack of patient education and inadequate medical care

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9
Q

S/S of asthma

A

wheezing
-high-pitched whistling sounds when breathing out - especially in children
cough, worse particularly at night
recurrent wheeze
recurrent difficulty in breathing
recurrent chest tightness
Sx occur or worsen at night, awakening the patient

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10
Q

asthma Sx occur or worsen in the presence of…

A 
exercise
viral infection
animals with fur or hair
house-dust mites
mold
smoke
pollen
changes in weather
strong emotional expression (laughing or crying hard)
airborne chemicals or dusts
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11
Q

key components of asthma

A

bronchoconstriction
swelling
mucus plug

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12
Q

asthma pathophysiology

A

intermediate type hypersensitivity reaction
mast cells release histamine
cells of immune system stimulate airway

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13
Q

intermediate type hypersensitivity reaction

-results in…

A

direct stimulation of airway muscle

indirect stimulation by mediator-secreting cells

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14
Q

asthma pathophysiology: cells of immune system stimulate airway

  • acute effects
  • chronic effects
A 
acute
-inflammation: increased capillary permeability
-smooth muscle contraction
chronic
-mucus production
-inhibition of mucociliary clearance
-airway changes
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15
Q

bronchial sensitivity: triggers

-examples

A

allergens
-pollen, animal dander, dust mites, cockroaches
irritants
-irritating substances (smoke, pollution, odors), sulfites (dried fruit, wine)
other
-weather/environmental
-exercise

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16
Q

asthma: results of inflammation

A

increased resistance to airflow –> increased work of breathing –> decreased ventilation

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17
Q

which measures are used to assist with diagnosing asthma

A 
FVC
FEV1
FEV1/FVC
FEF25-75
-average rate of flow at mid-exhalation
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18
Q

diagnosis of asthma

A

spirometry to establish airway obstruction

post-bronchodilator response - primary test to diagnose asthma

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19
Q

airway obstruction measures for a diagnosis of asthma

A

FEV1 < 80% predicted

FEV1/FVC < 65% of predicted

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20
Q

in terms of reversibility with asthma, what do we want the FEV1 to do after short acting beta2-agonist

A

FEV1 increases > 12% with >/= 200 ml change

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21
Q

asthma: other diagnostic tests (other than post-bronchodilator response)

A

exercise challenge

methacholine challenge

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22
Q

asthma classification severities

-what features are looked at

A 
severe persistent
moderate persistent
mild persistent
mild intermittent
classified according to their most severe feature
-days with Sx
-nights with Sx
-PEV or FEV1
-PEF variability
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23
Q

common medications used to treat asthma

A

albuterol
atrovent
salmeteral (Serovent)
inhaled steroids

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24
Q

albuterol

  • MOA
  • onset
  • duration
A 
B2 selective bronchodilator
onset
-5-15 minutes
duration
-3-6 hours
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25
atrovent - MOA - onset - duration
``` MOA -anticholinergic, prevents bronchoconstriction onset -15 minutes duration -3-4 hours ```
26
salmeteral - MOA - onset - duration
``` B2 bronchodilator onset -10-20 minutes duration -12 hours ```
27
pharmacotherapy: persistent asthma needs 2-step process
``` long-term control -steroids, leukotriene antagonists -long active beta agonist acute exacerbations -albuterol or short acting best agonist ```
28
asthma | -what is stepwise control
need a baseline | need inhaler with you
29
asthma treatment guidelines | -focus on what components of asthma care
measures to assess and monitor asthma patient education control of environmental factors and other conditions that can worsen asthma medications
30
asthma: periodic assessment components
teach all patients with asthma to recognize symptoms that indicate inadequate asthma control patients should be seen by a clinician at least every 1-6 months
31
asthma: patient education
self-monitor and manage asthma action plan -daily strategies and exacerbations new settings include pharmacies, community centers
32
asthma comorbidities
obesity sinusitis GERD sleep apnea
33
long-term consequences of asthma
``` hyperexpansion of thorax postural changes decreased physical fitness school absence restricted physical activity change in family-social systems increased hospitalizations ```
34
effect of breathing exercise on asthma
FEV1 and FVC showed non-significant results PEFR showed significant improvement decreased rescue beta agonist use reduced corticosteroid use
35
EIA | -incidence
3-10% 35-50% incidence in cold weather athletes -figure skater, ice hockey, nordic skiing
36
factors most likely to cause EIA
continuous hard exercise exercise in cold environment exercise in polluted air exercise in pollen season for allergic athletes exercise during upper respiratory infection
37
PT treatment implications for asthma
pre-treat with beta agonist before exercise measure peak flow before and after exercise listen for wheezing before and after exercise early and longer warm-up period increase humidity in exercise area have patient breathe through nose short exertion periods (intermittent exercise) may decrease need for medications
38
physical training and asthma
physical training is well tolerated among people with asthma in the included studies
39
cystic fibrosis | -what is it
congenital disease of exocrine glands symptomatic individuals must inherit a defective gene from each parent "the infant that tastes of salt will surely die" -European folklore
40
cystic fibrosis transmembrane conductance regulator (CFTR) gene - what is it - what happens to it in CF
normally opens channel through plasma membrane of cell to allow chloride to pass through in defective gene -faulty salt movement of Na+ and Cl-
41
what is the initial test for CF | -why?
sweat test | sweat glands will produce saltier secretions
42
CFTR gene and airways
the CFTR protein regulates channels that allow the Cl- ions to exit airway cells normally, Na+ ions follow the Cl-, and the NaCl combination pulls out water to line the airway with fluid in CF cells, the defective CFTR protein blocks the Cl channels, so too much sodium and water are pulled into the cell, leaving behind dry mucus
43
consequences of defective CFTR
in healthy lungs, the fluid lining the airway traps potentially harmful substance, and the cilia beat in a coordinated manner to sweep the foreign substances out in CF lungs, the airway fluid is mostly a mucus so thick and sticky that the cilia can hardly move -bacteria stay trapped and can eventually cause infections
44
intestinal blockage with CF
since salt and water stay in the cells, there is less water in the intestines
45
effect of CF on pancreas - function when healthy - what changes with CF
pancreative enzymes help break down proteins, fats, and carbs in CF -epithelial dysfunctiion -pancreatic enzymes do not cross cell membrane -also get mucus blocks
46
consequences of CF
severe lung infections decreased release of pancreatic enzymes -poor nutrition reproductive blockage
47
additional consequence of CF
oxygen deprivation | -clubbed fingers: sign of hypoxemia (poor gas exchange)
48
common pulmonary infections - what are they - how are they transmitted - how do they colonize
staphylococcus aureus -early pseudomonas aeruginosa -primary transmitted by respiratory or hand contact usually colonize in lungs and difficult to eradicate
49
explain bronchiectasis
mucus production increases, the cilia are destroyed or damaged, and areas of the bronchial wall become chronically inflamed and are destroyed
50
treatment of pulmonary infections
inhaled bronchodilator mucolytics airway clearance -AD or ACB (autogenic drainage; active cycle of breathing) -ThAirapy Vest -NEED TO COUGH AFTER THESE TREATMENTS TO REMOVE MUCUS antibiotics
51
pulmonary medications
beta agonist bronchodilators Pulmozyme guaifenesin
52
Pulmozyme - function - MOA
inhaled medication that thins mucus | acts by breaking down DNA in sputum and thinning secretions
53
Guaifenesis | -function
oral medication that thins mucus
54
pulmonary infection antibiotics
aminoglycosides inhaled tobramycin TOBI azithromycin
55
new pharmacoloy therapies for pulmonary infections
Ivacaftor | -CFTR potentiator
56
rheumatoid diseases in patients with CF
cystic fibrosis arthropathy hypertrophic arthropathy osteoporosis
57
CF arthropathy - prevalence - S/S - radiograph findings - occurs with... - may respond to...
8-10% of CF S/S -recurrent, painful mono or poly-arthritis -erythema nodosum rash normal radiograph or joint effusion occurs with late pulmonary or pancreatic manifestations may respond to NSAIDs
58
hypertrophic pulmonary osteoarthropathy (HPOA) - prevalence - linked with... - Sx of... - possible abnormal... - treated with...
``` occurs in 2-7% of CF adults linked with disease severity Sx of -finger clubbing -chronic inflammation (periostitis) of long obnes -joint inflammation of wrist, knee, ankle possible abnormal platelet function treated with NSAIDs ```
59
if having an individual with CF exercise, what do you need to be prepared to do
facilitate the removal of dislodged mucus
60
what are components of effective CF treatment
``` exercise breathing training monitor airway clearance educate ```

S2 MAP II (17 decks)

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