Asthma, COPD, Cystic Fibrosis

Question 1

Asthma

Answer 1

Asthma is a chronic inflammatory lung disease that results in recurrent episodes of
airflow obstruction, but it is usually reversible. The chronic inflammation causes an
increase in airway hyperresponsiveness that leads to recurrent episodes of wheezing,
breathlessness, chest tightness, and cough, particularly at night or in the early
morning.

Question 2

Triggers of Asthma

Answer 2

o Allergic asthma may be related to allergies, such dust, pollen, grasses, mites, roaches, moulds, animal dander, or latex.
o Asthma that is induced or exacerbated during physical exertion is called exercise-induced asthma (EIA). Typically, this type of asthma occurs after vigorous exercise, not during it.
o Respiratory infections (particularly viral) are the major precipitating factor of an acute asthma attack.
o Sensitivity to specific drugs may occur in some asthmatic persons, especially those with nasal polyps and sinusitis, resulting in an asthma episode.
o Gastroesophageal reflux disease (GERD) can also trigger asthma.
o Various air pollutants, cigarette or wood smoke, vehicle exhaust, diesel particulate, elevated ozone levels, sulphur dioxide, and nitrogen dioxide can trigger asthma attacks.
o Crying, laughing, anger, and fear can lead to hyperventilation and hypocapnia, which can cause airway narrowing.
o Occupational asthma occurs after exposure to agents of the workplace

Question 3

clinical manifestations of asthma

Answer 3

wheezing, cough, dyspnea, and chest tightness after exposure to a precipitating factor or trigger. Expiration may be prolonged.

Question 4

The severity of asthma is determined by what?

Answer 4

the frequency and duration of symptoms, the presence of persistent airflow limitation, and the medication required to maintain control

Question 5

Severe acute asthma can result in complications such as:

Answer 5

pneumothorax, pneumomediastinum, acute cor pulmonale with right ventricular failure, and severe
respiratory muscle fatigue that leads to respiratory arrest (which can be fatal).

Question 6

Two main features must be considered in the diagnosis of asthma:

Answer 6

symptoms and variable airflow obstruction. A detailed history is important in determining whether a person has had previous attacks of a similar nature, often precipitated by a known cause or trigger

Question 7

In all patients who are able to perform pulmonary testing, what should happen?

Answer 7

clinically suspected asthma should be confirmed with objective lung measurements that demonstrate postbronchodilator reversible obstruction, variable airflow limitation over time, or airway hyper-responsiveness.

Question 8

What is the preferred test for diagnosing asthma?

Answer 8

Spirometry

Question 9

What does alternative lung testing include?

Answer 9

variations in PEFR and bronchoprovocative challenge testing.

Question 10

Patient education remains the cornerstone of asthma management and should be carried out by healthcare providers providing asthma care. Several components enable successful management of asthma are:

Answer 10

(1) establishment of a confirmed diagnosis through the use of objective measures;
(2) development of a partnership between
health care providers and the patients and families affected by asthma;
(3) limited exposure to triggers;
(4) education of patients;
(5) appropriate pharmacotherapy;
(6) continuous assessment and monitoring of asthma control and severity;
(7) implementation of a written action plan; and
(8) ensuring regular follow-up.

Question 11

Medications for asthma are divided into two general classifications:

Answer 11

(1) relievers (“rescue” medication used intermittently as required to ease asthma symptoms)
(2) controllers (maintenance therapy used on a daily basis, typically twice a day).

Question 12

Role of corticosteroids in asthma

Answer 12

Because chronic inflammation is a primary component of asthma, corticosteroids, which suppress the inflammatory response, are the most potent and effective anti-inflammatory medication currently available to treat asthma

Question 13

Role of Mast cell stabilizers in asthma

Answer 13

Mast cell stabilizers are nonsteroidal anti-inflammatory drugs that inhibit the IgE mediated
release of inflammatory mediators from mast cells and suppress other inflammatory cells (e.g., eosinophils).

Question 14

Role of leukotriene modifiers in asthma

Answer 14

The use of leukotriene modifiers can successfully be used as add-on therapy to reduce (not substitute for) the doses of inhaled corticosteroids.

Question 15

Role of Short-acting inhaled β2-adrenergic agonists in asthma

Answer 15

Short-acting inhaled β2-adrenergic agonists are the most effective drugs for relieving acute bronchospasm. They are also used for acute exacerbations of asthma.

Question 16

Role of Methylxanthine (theophylline) preparations in asthma

Answer 16

Methylxanthine (theophylline) preparations are less effective long-term control bronchodilators as compared to β2-adrenergic agonists.

Question 17

Role of Anticholinergic agents in asthma

Answer 17

Anticholinergic agents (e.g., ipratropium [Atrovent], tiotropium [Spiriva]) block the bronchoconstricting influence of parasympathetic nervous system

Question 18

One of the major factors for determining success in asthma management is what?

Answer 18

The correct administration of drugs.

Question 19

Inhalation devices include:

Answer 19

metered-dose inhalers (with or without spacers), dry powder inhalers, and wet nebulizers.

Question 20

The goal of asthma care

Answer 20

To maximize the ability of the patient to safely manage acute asthma episodes via an asthma action plan developed in conjunction with the healthcare provider. An important nursing goal during an acute attack is to decrease the patient’s sense of panic.

Question 21

Who should be involved in care planning of asthma patients?

Answer 21

Written asthma action plans should be developed together with the patient and family, especially for those with moderate or severe persistent asthma or a history of severe exacerbations.

Question 22

Chronic obstructive pulmonary disease

Answer 22

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette
smoking.

Question 23

Risk factors for Chronic obstructive pulmonary disease

Answer 23

In addition to cigarette smoke, occupational chemicals, and air pollution, infections are risk factors for developing COPD. Severe recurring respiratory tract infections in childhood have been associated with reduced lung function and increased respiratory
symptoms in adulthood.

Question 24

α1-Antitrypsin (AAT) deficiency

Answer 24

An autosomal recessive disorder, a genetic risk

factor that can lead to COPD.

Question 25

Aging results in changes in what structures to cause COPD?

Answer 25

The lung structure, the thoracic cage, and the respiratory muscles, and as people age there is gradual loss of the elastic recoil of the lung. Therefore, some degree of emphysema is common in the lungs of the older person, even a nonsmoker.

Question 26

COPD encompasses two types of obstructive airway diseases:

Answer 26

chronic bronchitis and emphysema.

Question 27

Chronic bronchitis

Answer 27

The presence of chronic productive cough for 3 months in 2 successive years.

Question 28

Emphysema

Answer 28

An abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.

Question 29

Symptoms of COPD

Answer 29

cough, sputum production, or dyspnea, and/or a history of exposure of risk factors for the disease. An intermittent cough, which is the earliest symptom, usually occurs in the morning with the expectoration of small amounts of sticky mucus resulting from bouts of coughing.

Question 30

COPD can be classified as…

Answer 30

mild, moderate, severe, and very severe.

Question 31

Complications of COPD include:

Answer 31

o Cor pulmonale is hypertrophy of the right side of the heart, with or without heart failure, resulting from pulmonary hypertension, and is a late manifestation of
COPD.
o Exacerbations of COPD are signaled by a change in the patient’s usual dyspnea, cough, and/or sputum that is different than the usual daily patterns. These flares
require changes in management.
o Patients with severe COPD who have exacerbations are at risk for the development of respiratory failure.
o The incidence of peptic ulcer disease is increased in the person with COPD.
o Anxiety and depression can complicate respiratory compromise and may precipitate dyspnea and hyperventilation.

Question 32

The diagnosis of COPD is confirmed by:

Answer 32

pulmonary function tests. Goals of the diagnostic workup are to confirm the diagnosis of COPD via spirometry, evaluate the severity of the disease, and determine the impact of disease on the patient’s quality of life. When the postbronchodilator FEV1/FVC ratio is less than 70%, it suggests the presence of airway obstruction.

Question 33

The primary goals of care for the COPD patient are to:

Answer 33

(1) prevent disease progression (smoking cessation)
(2) reduce the frequency and severity of exacerbations, (3) alleviate breathlessness and other respiratory symptoms
(4) improve exercise tolerance and daily activity
(5) treat exacerbations and complications of the disease
(6) improve health status and quality of life, and
(7) reduce the risk of mortality.

Question 34

Single most effective intervention to reduce the risk of developing COPD and stop the progression of the disease.

Answer 34

Cessation of cigarette smoking in all stages of COPD

Question 35

Oxygen Therapy in COPD

Answer 35

Oxygen therapy is frequently used in the treatment of COPD and other problems associated with hypoxemia. Long-term O2 therapy improves survival, exercise capacity, cognitive performance, and sleep in hypoxemic patients.
o O2 delivery systems are classified as low- or high-flow systems. Most methods of
O2 administration are low-flow devices that deliver O2 in concentrations that vary with the person’s respiratory pattern.
o Dry O2 has an irritating effect on mucous membranes and dries secretions. Therefore it is important that O2 be humidified when administered, either by humidification or nebulization.

Question 36

Two different surgical procedures have been used in severe COPD:

Answer 36

o Lung volume reduction surgery is used to reduce the size of the lungs by removing about 20 to 35% of the most diseased lung tissue so the remaining healthy lung tissue can perform better.
o In selected patients with very advanced COPD, lung transplantation improves functional capacity and enhances quality of life

Question 37

Pulmonary rehabilitation programs (PRPs) are used to…

Answer 37

optimize the functional status of patients with COPD—as well as their quality of life, experience of dyspnea,
exercise endurance, psychosocial functioning, and overall autonomy.

Question 38

Specific components of a PRP can include:

Answer 38

exercise conditioning (aerobic and upper and lower body conditioning), breathing exercises, energy conservation, nutrition, smoking cessation, environmental factors, health promotion, patient education and self-management, psychological support, psychological counselling, and vocational rehabilitation.

Question 39

Pursed-lip breathing

Answer 39

A technique that is used to prolong exhalation, prevent
bronchiolar collapse and air trapping, and assist with dyspnea. Exhalation should be at least three times longer than inhalation

Question 40

The main goals of effective coughing are?

Answer 40

to conserve energy, reduce fatigue, and facilitate removal of secretions. Huff coughing is an effective technique that the patient can be easily taught.

Question 41

Weight loss and COPD

Answer 41

Weight loss and malnutrition are commonly seen in the patient with severe emphysematous COPD. The client with COPD should try to keep the body mass index (BMI) between 21 and 25 kg/m2

Question 42

The patient with COPD will require acute intervention for complications such as:

Answer 42

exacerbations of COPD, pneumonia, cor pulmonale, and acute respiratory failure.

Question 43

Pulmonary rehabilitation should be considered for all patients with…

Answer 43

symptomatic COPD or having functional limitations. The overall goal is to increase the quality of life.

Question 44

Cystic fibrosis (CF)

Answer 44

an autosomal recessive, multisystem disease characterized by altered function of the exocrine glands primarily involving the lungs, pancreas, and sweat glands.

Question 45

Process of Cystic fibrosis (CF)

Answer 45

Initially, CF is an obstructive lung disease caused by the overall obstruction of the airways with mucus. Later, CF also progresses to a restrictive lung disease because of the fibrosis, lung destruction, and thoracic wall changes.

Question 46

The major objectives of therapy in CF are?

Answer 46

(1) promote clearance of secretions
(2) control infection in the lungs
(3) provide adequate nutrition.