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Drug Action I > Block 1 - Asthma + COPD Physiology > Flashcards

Block 1 - Asthma + COPD Physiology Flashcards

1
Q

Physiology

Respiration is responsible for ___

A

Gas exchange

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2
Q

Physiology

Ventilation is responsible for ___

A

Moving air in and out of the lungs

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3
Q

Physiology

What are the functions of the diaphragm?

A
  1. Seperates the chest from the abdomin
  2. Creates a suction from moving downward and expanding the lungs by drawing air
  3. Aids in breathing
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4
Q

Physiology

Where are intercostal muscles located?

A

Between ribs forming the chest wall

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5
Q

Physiology

What is the difference between external and internal intercostal muscles?

A

External: quiet and forced inhalation
Internal: forced expiration

Quiet expiration = passive process

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6
Q

Respiration

What is dyspnea?

A

Difficult or labored breathing

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7
Q

Respiration

What is apnea?

A

Absence of breathing

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8
Q

Respiration

What is tachypnea?

A

Increased frequency of respiratory rate

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9
Q

Respiration

What is orthopnea?

A

dyspnea when recumbent, relieved when placed upright (CHF, asthma, lung failure)

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10
Q

Respiration

What is the purpose of the main entrance of the nasal cavity?

A
  1. Warms and saturates inspired air
  2. Removes bacteria and debris
  3. Converes heat and moisture from expired air
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11
Q

Respiration

What is the purpose of nasal hair?

A

Purify and filter air

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12
Q

Respiration

What are the routes of air entry?

A

nasal and oral

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13
Q

Respiration

Describe the function of the pharynx

A

Collects incoming air from the nose and passes it down (part of digestive and respiratory)

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14
Q

Respiration

Describe the function of the epiglottis

A

guards the entrance to the trachea

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15
Q

Respiration

What happens when the epiglottis is at rest vs swallowing?

A

Rest: upright allowing air to pass to larynx
Swallowing: folds back to cover entrance, preventing food and drinks to enter the trachea

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16
Q

Respiration

Describe the function of the larynx

A

contains vocal cords, used to create sound

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17
Q

Respiration

What are the components of the upper respiratory tract?

A
  1. Pharynx
  2. Epiglottis
  3. Larynx
  4. Nasal/Oral Cavity
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18
Q

Respiration

What are the components of the lower resp tract?

A
  1. Bronchi
  2. Bronchioles
  3. Alveloli
  4. Capillaries
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19
Q

Respiration

Describe cells associated with bronchi?

A

Ciliated epithelial columnar: carries mucus, phlegm, liquid upward and out into the throat to be coughed up or swallowed
Goblet: Secretes mucus

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20
Q

Respiration

Describe the structure of bronchioles

A

Lined by smooth muscle and under autonomic control

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21
Q

Respiration

Describe the function of alveoli

A

Site of gas exchange with blood

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22
Q

Respiration

Describe the function of the capillaries in the lower resp tract

A

Region of gas diffusion down its concentration gradient

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23
Q

Respiration

What is pulmonary surface tension?

A

The attraction of water molecules along alveolar walls over air

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24
Q

Respiration

What is the function surfactant?

A

Limit surface tension in alveoli, preventing its collapse during inhalation

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25
Q

Respiration

What is the composition of pulmonary surfactant?

A

In order to create a water-air interface, surfactant is composed of phospholipids and apoproteins that creates a barrier between alveoli and air

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26
Q

Respiration

What cell secretes surfactant?

A

Type 2 alveolar epithelial cells lining alveoli and respiratory bronchioles

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27
Q

Respiration

Explain why premature infants are suceptible to respiratory distress?

A

Surfactant forms later in the fetus’s life

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28
Q

Respiration

What cells secrete mucous in the bronchi?

A

goblet cells

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29
Q

Pulmonary Circulation

What is the standard pulmonary arterial pressure?

A

25/8

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30
Q

Pulmonary Circulation

Describe the gas exchange in process in the alveoli

A

Exchange occurs passively based on gas pressure gradient

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31
Q

Pulmonary Circulation

What is the normal transit time through pulmonary capillaries?

A
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32
Q

Pulmonary Circulation

At rest, when is the blood fully oxygenated?

A

0.8 sec

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33
Q

Pulmonary Circulation

under high cardiac output, what is the transit time for full oxygenation?

A

0.3 sec

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34
Q

Pulmonary Circulation

What’s the difference between perfusion and diffusion limited?

A

Perfusion limited: occurs at normal states where a partial pressure gradient is maintained and equilibrium can be met
Diffusion limited: incomplete equilibrium from fibrotic disease states that alter the membrane

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35
Q

Pulmonary Circulation

What is primarily carried in plasma?

A

Bicarbonate

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36
Q

Pulmonary Circulation

How is HCO3 carried throughout the body?

A
  1. Bicarbonate in plasma (70%)
  2. CO2 bound to Hb (30%)
  3. Dissolved CO2 in plasma (10%)
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37
Q

Pulmonary Circulation

What is an excess of HCO3?

A

Hypercapnia

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38
Q

What are CNS chemoreceptors in the respiratory centers?

A

Monitor [H+] to control rate of respiration

Sensitive to changes in the CSF

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39
Q

What are periphery chemoreceptors?

A

Locates in aortic bodies and monitors oxygen by oxygen sensitive K+ channels

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40
Q

What is the lethal range of carbon monoxide?

A

0.6 mmHG

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41
Q

What makes carbon monoxide dangerous?

A

250x greater affinity for Hb than O2

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42
Q

What is spirometry?

A

Tests lung function, full inspiration followed by maximal forced expiration (3 times)

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43
Q

What is tidal volume?

A

500 mL, air moved in and out by normal breathing

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44
Q

What is inspiratory reserve volume?

A

3100 mL, max volume one can normally inspire

45
Q

What is expiratory reserve volume?

A

1200 mL, max amount one expire normally

46
Q

What is residual volume?

A

1200 mL, volume left in lungs after maximum expiratory effort

47
Q

What is vital capacity?

A

IRV+TV+ERV (max volume exchanged in a rep cycle, 4800 mL)

48
Q

What is total lung capacity?

A

6000 mL (all air in full inflation, IRV+TV+ERV+RV)

49
Q

What is the normal volume of respiration in a male?

50
Q

What is alkalosis and how is it resolved?

51
Q

What is acidosis?

52
Q

Describe how HCO3 is carried throughout the body?

53
Q

What is acidosis?

53
Q

Describe how HCO3 is carried throughout the body?

53
Q

What is alkalosis and how is it resolved?

54
Q

What is FVC?

A

Forced vital capacity: amount of air that forcefully by blown out after a full inspiration (5.0L for males)

55
Q

What is FEV1?

A

Forced expiratory volume in 1 second: amount of air that can forcefully be blown in 1 sec (4.0L)

56
Q

What is FEV1/FVC?

A

Ratio that shows percentage of FVC (80% is healthy)

57
Q

What can expect with a pulmonary disease regarding its spirometry reading?

A

FEV1 would be significantly lower, FVC would be lower as well

58
Q

What is PEF?

A

Peak expiratory flow: captures the peak speed of air moving out of lungs at the beginning of expiration (home setting)

59
Q

What is asthma?

A

Chronic inflammation mainly in bronchioles caused by hypersensitivity to allergens

60
Q

What are the hallmarks of asthma?

A
  1. Coughing
  2. SOB
  3. Chest tighness
  4. Wheezing
61
Q

What is the difference between mild and severe asthma?

A

Mild: intermittent symptoms
Severe: persistant, especially at night

62
Q

What system regulates size of bronchiole lumen (smooth muscle)

A

Autonomic
Sympathetic: bronchodilator via epinephrine
Cholingeric: bronchoconstriction via ACh

63
Q

What are the characteristics of asthma?

A
  1. Inflammation in bronchial walls and cell infiltration
  2. reversible airflow obstruction
  3. Increased mucous secretion
64
Q

What dictates asthma severity?

A

Degree of hyper-responsiveness

65
Q

How do you test for asthma?

A

Spirometry after methacholine or histamine inhalation challenge

66
Q

What are the pathological features of asthma?

A
  1. inflammatory cell infiltration (eosinophils, neutrophils, and lymphocytes)
  2. edema
  3. mast cell activation
  4. airway remodeling
  5. collagen deposition beneath the basement membrane
67
Q

What is a strong cause for childhood asthma?

68
Q

What is atopy?

A

Increased IgE antibodies from environmental antigens

69
Q

What causes airway obstruction and narrowing associated with asthma?

A
  1. Degree of airway smooth muscle contraction
  2. Smooth muscle hypertrophy
  3. Mucus plugging for sloughed epithelial and inflammatory cells
  4. Edema
  5. Over inflation from trapped air
70
Q

What is nocturnal asthma and what is the preferred medication?

A

Asthma that awakens the patient at night, treated by LABAs

Increased catecholamines an GC causing edema and increased mediators

71
Q

What occurs during the early stage of asthma?

A
  1. IgE/Antigen crosslinking leads to release of mast cell contents (inflammatory mediators)
  2. Inflammatory mediators open the tight junctions between the epithelial cells
  3. Antigens enter the mucosa and further activate mucosal mast cells, eosinophils and vagal afferent nerves
  4. This causes further release of inflammatory mediators by mast cells and eosinophils
  5. Causing bronchospasm, increased vascular permeability, and increased mucus production
72
Q

What occurs during late phase of asthma?

A
  1. Recruitment and infiltration of mediators releasing leukocytes
  2. continuous releases of inflammatory mediators
  3. Increased mucous and damage to epithelial
  4. Epithelial shedding and airway remodeling
73
Q

Describe the mechanism how allergens can lead to asthmatic symptoms?

74
Q

What is released during mast cell degranulation?

A

Histamine, LK, PG, CK

75
Q

What secretes IL for inflammatory responses?

A

Type 2 helper T cells

76
Q

What is the function for IGE?

A

Induces growth and degranulation of mast cells

77
Q

What are IL4 and 13?

A

Stimulates B cells to increase production of IgE

78
Q

What are IL3 and 5?

A

Released by TH2 and mast cells to increase eosinophil recruitment and activation

79
Q

What characteristics do we look for when diagnosing asthma?

A
  1. history/pattern of symptoms
  2. lung function measurements
  3. airway responsiveness
  4. risks and triggers
80
Q

What are the symptoms and function for stage 1 asthma?

A

Mild intermittent
≤ 2/week, nigh ≤ 2/month
Asymptomatic
Brief exacerbations

FEV1: ≥80%
PEV: 30%

81
Q

What are the symptoms and function for stage 2 asthma?

A

Mild persistant
>2/week, <1/day
Night: 2-4/month
Systemic steroid ≤2/yr

FEV1: ≥80%
PEV: 30%

81
Q

What are the symptoms and function for stage 2 asthma?

A

Mild persistant
>2/week, <1/day
Night: 2-4/month
Systemic steroid ≤2/yr

82
Q

What are the symptoms and function for stage 3 asthma?

A

Moderate persistant
Daily
Night: >1/week
SABAs

FEV: 60-80%
PEV: >30%

83
Q

What are the symptoms and function for stage 4 asthma?

A

Severe persistant
Continual
SABAs
Frequent night symptoms

FEV: ≤60%
PEV: >30%

84
Q

What is COPD?

A

Persistant respiratory symptoms and airflow limitations caused by airway or alveolar abnormalities from smoking, notorious particles, or gases

85
Q

What is the major risk factor for COPD?

A

Tobacco smoking

86
Q

What are the characteristics of COPD?

A
  1. Chronic bronchitis
  2. Emphysema
  3. Preventable but irreversible
  4. Systemic consequences
87
Q

How does COPD treatment differ from asthma?

A

low FEV1 value doesn’t respond to bronchodilators due to the irreversible airway damage

88
Q

What is the burden of COPD?

A

The leading cause of morbidity and mortality worldwide

89
Q

What are the key indicators for diagnosing COPD?

A
  1. Chronic cough
  2. Chronic sputum
  3. Dyspnea that is progressive and persistant
  4. Acute bronchitis
  5. Risk factor history like smoking
90
Q

What are the dangers of chronic bronchitis?

A

Inflammation and obstruction of airways lead to excessive mucous, coughing, and infection impairing gas exchange -> hypoxemia (Blue bloaters) -> cyanosis -> decreased tissue oxygen perfusion

91
Q

What are the dangers of emphysema?

A

Lung hyperinflation (pink puffers), prominent respiratory muscles and flattened diaphragm, diminishing breathing sounds

92
Q

How can emphysemas cause structural changes?

A
  1. hyperinflation of alveoli
  2. Destruction of alveolar and capillary walls
  3. small airway narrowing
  4. Lung elasticity decreases
93
Q

What is the mechanism of emphysema structural changes?

A
  1. obstruction of bronchioles
  2. prolytic enzymes destroy alveolar
  3. elastin and collagen are destroyed
94
Q

What is cor pulmonale?

A

Pulmonary HTN from right ventricle work load causing increased fibers and stretch, fluid collecting in interstitial spaces creating a crackles

95
Q

What is polycythemia?

A

Increased blood viscosity

96
Q

What is the protease-antiprotease theory and how does it pertain to COPD?

A

Proteases are released by neutrophils than increases lung size and elasticity -> protease is inhibited by a1AT -> a1AT is inhibited by smoke and free radicals from stimulated neutrophils -> increased cellular damage -> emphysema

97
Q

What are the dangers of A1AT deficiency?

A
  1. raises the risk for lung and live disease
  2. early development of COPD
98
Q

What do we assess for COPD?

A
  1. Degree of airflow limitation using spirometry
  2. Symptoms
  3. Risk of exacerbations
  4. comorbidities
99
Q

How should you assess COPD airflow limitations?

A
  1. Spirometry with a adequate dose of a short acting bronchodilators
  2. However, FEV1 is not generally increased by bronchodilators in COPD
  3. FEV1/FVC < 70%
100
Q

How should you assess COPD symptoms?

101
Q

What are is mild COPD?

A

GOLD 1: Mild
FEV1 > 80% predicted

102
Q

What is moderate COPD?

A

GOLD 2: Moderate
50% < FEV1 < 80%

103
Q

What is severe COPD?

A

GOLD 3: Severe
30% < FEV1 < 50% predicted

104
Q

What is very severe COPD?

A

GOLD 4: Very Severe
FEV1 < 30% predicted

105
Q

How should you assess risk of exacerbations?

A
  1. Use history and spirometry
  2. Two or more exacerbations within the last year or an FEV1 < 50 % of predicted value are indicators of high risk

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