ASTHMA & NEUROMUSCULAR

Question 1

What are some asthma triggers to watch out for?

Answer 1

Dust, perfume, cold air, allergies, smoke or physical activity

Question 2

What is a management medication regimen for asthma?

Answer 2

rescue inhaler (SABA, albuterol) and a combination of fluticasone propionate with budesonide, which is an ICS +LABA combo

Question 3

What is a clinical presentation of an asthmatic patient?

Answer 3

Tripod position and increased WOB

Question 4

What is a common breath sound for asthmatic patients?

Answer 4

bilateral expiratory wheeze on upper and lower lobes

Question 5

What would we use as a rescue drug class to treat asthmatic patients with in order to treat for inflammation/bronchospasm?

Answer 5

Short-acting beta agonist

Question 6

What did the PFT values indicate for the asthmatic patient?

Answer 6

Restrictive airflow but it is typically an obstructive disease

Question 7

What is the reason for pet allergy irritation?

Answer 7

Due to the dander they carry in their hair

Question 8

What is a safer mode of ventilation for ALS patients as a preventative measure?

Answer 8

Low tidal volume ventilation

Question 9

What is a passy muir valve?

Answer 9

It allows a person on a ventilator to be able to swallow and speak. The valve is a one-way valve that allows air to pass out but not in. Always deflate the cuff.

Question 10

Can short beta agonists prevent asthma exacerbations?

Answer 10

No, they are only there to relieve symptoms when you experience.

Question 11

What happens over time with the usage of bronchodilators?

Answer 11

It desensitize their response to these bronchodilators and they get worse and worse that they feel the need to go to the emergency department.

Question 12

How does ALS affect primary? What does this cause over time?

Answer 12

Nerves connecting to the brain and muscles. Overtime ALS patients lose more and more of their muscle function until they end up on the ventilator.

Question 13

Which are the 3 muscles groups affected in ALS?

Answer 13

1. Swallowing muscles
2. Inspiratory muscles
3. Expiratory muscles

Question 14

Which muscle group helps us cough?

Answer 14

Expiratory muscles

Question 15

Which muscle group helps us protect our airways?

Answer 15

Swallowing muscles

Question 16

What are some of the lost functions over time in ALS?

Answer 16

Loss of diaphragm and accessory muscles use
Loss of swallowing reflexes use

Question 17

What occurs when we move our arms or legs? What are the building blocks of these networks?

Answer 17

A signal is transmitted from the brain, down the spinal cord, and via a variety of neural networks to make it happen. The nerve cells and neurons are the building blocks of these networks.

Question 18

What are signals relating to which convey back to the brain from the body?

Answer 18

Heat
Cold
Pain

Question 19

How does ALS attack the nerves in its network?

Answer 19

ALS attacks the nerves in these networks, degrading them to the point where they become unusable.

Question 20

What usage makes feeding simpler for ALS patients?

Answer 20

PEG tube

Question 21

How does swallowing work for ALS?

Answer 21

-An extremely complicated task
-Get all water into one place of your mouth and launch back to the pharynx closing the glottis to the epiglottis. The parasytlists of the esophagus will take over.
-When it fails it is disastrous, fails occasionally for us
Crackers and think liquids are the worst to swallow, ask if they have difficulty at these 2 extremes, the easiest is pudding
-PEG tube, don’t have to worry about swallowing for nutrition
-Saliva causes drowning
-Anticholinergics for secretions, won’t have to suction as often
-Too much oxygen kills the respiratory drive, the patient goes apnic.

Question 22

What is the alveolar gas relationship? Between O2 and CO2?

Answer 22

When oxygen goes up the respiratory drive goes down and the CO2 will go up.

Question 23

What does PaO2 need to be in COPD patients?

Answer 23

60-80

Question 24

What causes hypercapnia coma?

Answer 24

CO2 over 100

Question 25

What responds to changes in O2 tension and CO2 tension in the blood or in the cerebrospinal fluid perfusing an area?

Answer 25

The central chemoreceptors in the medulla oblongata.

Question 26

What do inhaled glucocorticoids include? And what does it help with?

Answer 26

Budesonide and Formoterol
It helps with decreasing inflammation in the airway as well as formoterol is a long-acting beta agonist.

Question 27

What are triggers vs. allergens’ influences on asthma attacks?

Answer 27

Triggers are instant to leading asthma attacks
while allergens build over time to cause asthma

Question 28

What role does the respiratory center play in causing an asthmatic patient to remain dyspneic despite supplemental oxygen and normal saturation?

Answer 28

The respiratory center is trying to keep the PaCO2 normal by normalizing minute ventilation.

Question 29

What is the way to fix an asthmatic patient to remain dyspneic despite supplemental oxygen and normal saturation?

Answer 29

Usage of bronchodilator and NOT oxygen

Question 30

What is a normal breathing function which lacks in ALS patients causing them to require positive pressure and MV?

Answer 30

When taking in air to our lungs using negative pressure created by the diaphragm this usage fails resulting in the need to use other methods of breathing such as positive airway pressure and MV.

Question 31

For many ALS patients what disease represents a major cause of morbidity and mortality?

Answer 31

Cardiac disease

Question 32

How do we help someone with ALS who lacks a strong cough but has a strong vital capacity? And how is this achieved?

Answer 32

Usage of a cough assist device.
This device preloads the lung with air by providing pressure support during the inhalation and creates negative pressure in the mouth in order to accelerate airflow out to assist in the cough.

Question 33

What can a constant weak cough result in and what role can the RT play in avoiding this result?

Answer 33

A constant weak cough may result in tracheostomy placement.
RTs can help by going in and getting the built-up sputum due to the patient being unable to excrete on their own.

Question 34

*What is asthma?

Answer 34

A heterogeneous disease usually characterized by chronic inflammation?

Question 35

*What are the symptoms of asthma? ex: physical presentation, breath sounds, etc… (list 4)

Answer 35

• wheeze,
• SOB
• chest tightness & cough (vary over time & in intensity)
• variable expiratory airflow limitation.

Question 36

*What does every asthma patient possess?

Answer 36

Airway inflammation

Question 37

*What are 4 asthma medications for management? Name an example for each.

Answer 37

1. Short acting beta agonist (Albuterol)
2. Steroids (Prednisone)
3. Combination of steroid and long-acting bronchodilator(ex: Symbicort, budesonide/ formoterol fumarate dihydrate)
4. Montelukast (Singulair)

Question 38

• What is short acting beta agonist such as albuterol’s mechanism on asthmatic patients?

Answer 38

This is good for opening an airway during an asthma attack but not good at preventing asthma.

Question 39

*What is a steroid such as prednisone’s mechanism on asthmatic patients?

Answer 39

Works slowly over several hours to reverse the swelling in the airways.

Question 40

*What is a combination of steroid & LABA such as Symbicort’s mechanism on asthmatic patients?

Answer 40

Prevent bronchospasm

Question 41

*What is a Montelukast such as Singulair’s mechanism on asthmatic patients?

Answer 41

Used to control and prevent symptoms caused by asthma such as wheezing, shortness of breath, chest tightness, and coughing.

Question 42

*What is another approach to effective severe asthma management?

Answer 42

Recognizing clinical phenotypes with specific molecular pathways involved in severe asthma and the integration of molecular targeted biological therapies for effective and safe patient management.

Question 43

*What is ALS?

Answer 43

A progressive nervous system disease that belongs to a group of disorders known as motor neuron diseases.

Question 44

*What is unique about ALS?

Answer 44

If it hits muscle groups at random then it is hard to predict what will happen next.

Question 45

*What are 3 muscle groups directly affected by ALS which is impairing ALS patients? And what does each group affect directly in relation to ALS?

Answer 45

1) Inspiratory muscles mainly the diaphragm when affected makes it difficult for the patient to lie down.
2) Expiratory muscles when affected impair an effective cough and take away the patient’s ability to protect their airway.
3) Swallowing muscles when compromised make it difficult to swallow and the ability to protect the airway will follow.

Question 46

*What is the needed cough peak flow (CPF) required for effective cough? A CPF less than how much will cause a failure to cough?

Answer 46

150 to 160 L/min is required for an effective cough and a CPF less than 150 L/min will cause a failure to cough.

Question 47

*What is the RCPs role when interacting with ALS patients?

Answer 47

-Assess muscle strength by measuring vital capacity (VC)

Question 48

*At what VC should MV be considered for ALS patients?

Answer 48

Below 1000L

Question 49

*At what VC of predicted is positive ventilation required at night?

Answer 49

At 50% of predicted

Question 50

*How does PMV work? Where is it attached? What is one important thing to remember?

Answer 50

A speaking valve used to help patients speak normally when reached.

It is a one-way valve that attaches to the outside opening of the tracheostomy tube & allows air to pass into the tracheostomy but not out through it.

One very important thing to remember is to be sure that the tracheostomy tube cuff is completely deflated when using a Passy-Muir valve.