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THE PATIENT > Asthma physiology > Flashcards

Asthma physiology Flashcards

1
Q

What is asthma?

A

Chronic disease of the airways causing inflammation of the lining and narrowing of the airways making it difficult to breathe due to increased responsiveness to a trigger or stimuli
• Hypersensitivity to stimuli
• Reversible obstructive lung disease: remove stimuli
• Contraction and constriction of airway smooth muscle

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2
Q

What causes asthma?

A

Exposure to allergens/triggers

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3
Q

What are the allergens/triggers that can cause asthma?

A 
Pollen
Dust mite 
Mould spores
Respiratory infections: common cold
Pollutants: smoke, car fume 
Pet hair 
Emotional stress 
Air pollution
Medications- BB, NSAID, aspirin
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4
Q

What medicines induce bronchodilation?

A

Beta 2 agonist- salbutamol

PDE inhibitors- xanthines-theophylline

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5
Q

MOA of B2 agonists

A

a. B2 agonist binds B2 Gs protein coupled receptor
b. G-protein complex produced
c. Adenylate cyclase activated
d. Increase cAMP by converting ATP to cAMP
e. Activates PKA
f. Inhibits phosphorylation of ca channels so less intracellular calcium concentration
g. Myosin light chain kinase inactivated
h. Decrease i smooth muscle cell contraction
Bronchodilation/relaxation of smooth bronchial airway muscle

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6
Q

MOA of PDE inhibitors

A

Inhibit cAMP breakdown by inhibiting phosphodiesterase so no camp to amp
Increases Camp and Cgmp: inhibits myosin light chain kinase
Maintains and increases smooth muscle relaxation
Inhibit inflammation
Inhibit leukotriene synthesis

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7
Q

What drugs decrease inflammation?

A

Corticosteroids e.g. beclomethasone

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8
Q

MOA of corticosteroids

A

a. Allergen contact airway epithelial cell
b. Inflammatory cytokines: ILK1 and TNF produced
c. Causes inflammation
d. Corticosteroid binds glucorticoid receptor which is anchored to cytoplasm by heat shock protein
e. Beclomethasone/glucocorticoid receptor complex forms and travels to nucleus
f. Complex binds cytokines
g. Transcription inhibited
h. Reduced cytokines and inflammation

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9
Q

What are the specialist treatments for asthma?

A

Monoclonal antibody- Omalizumab

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10
Q

MOA of omalizumab

A

○ Allergen/IgE complex binds to FC receptor causing Inflammatory mediator production of histamine, cytokine and prostaglandins
○ Omalizumab inhibits IgE binding receptors on mast cell, basophil, dendritic cells by binding to Fc region IgE
Reduced inflammatory compound production

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11
Q

What structure regulates breathing?

A

Brain stem= pons and medulla

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12
Q

Describe the mechanism of breathing control?

A

Neurons extend from the pons and medulla of the brainstem to the spinal cord specifically the diaphragm and chest wall muscles
Neurons control muscle contraction and relaxation

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13
Q

Why is breathing controlled?

A

To maintain PaCO2 and PaO2 within normal ranges

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14
Q

What structures sense levels of CO2, O2 and ph in the body?

A

Chemoreceptors

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15
Q

What are the 2 types of chemoreceptors?

A
  1. Central chemoreceptors

2. Peripheral chemoreceptors

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16
Q

Where are Central chemoreceptors located?

A

brain stem medulla

17
Q

Where are Peripheral chemoreceptors located?

A

carotid bodies of the common carotid arteries and in the aortic bodies at the arch of the aorta

18
Q

What do Peripheral chemoreceptors detect?

A

Ph

PaCO2

19
Q

What do Central chemoreceptors detect?

A

Ph
PaCO2
PaO2

20
Q

At which location do Central chemoreceptors detect?

A

cerebrospinal fluid in the CNS

21
Q

At which location do Peripheral chemoreceptors detect?

A

arterial blood

22
Q

What are Central chemoreceptors sensitive to?

A

Low PaO2
High PaCO2
Low blood Ph/H+

23
Q

What are Peripheral chemoreceptors sensitive to?

A

Low Ph/H+

High PaCO2

24
Q

What muscles contract to adjust breathing?

A

intercostal muscle of the diaphragm

25
Q

What is pulmonary ventilation?

A

MOvement of air in and out of the lungs and the exchange of gases O2 and CO2 across the respiratory membrane

26
Q

Describe the tidal volume?

A

at rest= 500ml

volume of air moved in or out of lungs at rest

27
Q

Describe the vital capacity?

A

maximum volume of air expelled after

maximum inspiration to full exhalation

28
Q

Describe the residual volume?

A

volume of air remaining in lungs after

maximal exhalation

29
Q

Describe the Total lung capacity?

A

total amount of air in the lungs after
maximal inhalation
vital capacity + residual volume

30
Q

What are the 2 types of ventilation?

A
  1. Minute ventilation

2. Alveolar ventilation

31
Q

What are the types of lung function/diagnostic tests?

A
  1. Spirometry

2. Peak flow meter test

32
Q

What is spirometry?

A

assess dynamic flow within the airways

measures total volume of air patient can expel from lungs

33
Q

What does spirometry measure?

A

FEV1 – Forced Exhalation Volume: max. volume of air exhaled in 1 second with
maximally forced effort from a position of maximal inspiration, measures airway calibre
FVC – Forced Vital Capacity: max. volume of air exhaled from lungs with
maximally forced effort from a position of maximal inspiration, measures lung size
FEV1/FVC (%): proportion of vital capacity, measures airflow obstruction

34
Q

Obstructive lung disease spirometry results

A 
FEV1 <80% predicted
FVC usually reduced but
to lower extent than FEV1
FEV1/FVC ratio reduced
(<0.7)
35
Q

Restrictive lung disease spirometry results

A

FEV1 <80% predicted
FVC <80% predicted
FEV1/FVC ratio normal
(>0.7)

36
Q

What is transpulmonary pressure?

A

TPP is the difference between alveolar pressure (Palv) and pleural pressure

37
Q

What is compliance?

A

A measure of how well the lungs change volume

THE PATIENT (8 decks)

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