Case study 2 (asthma) Flashcards
Describe asthma
Chronic inflammatory airway disease
What happens to the airways of people who suffer from asthma
Hyperactive airways respond to various stimuli by widespread inflammation
Muscles around the airways tighten, making airways narrower
The airway lining also becomes inflamed, causing a build-up of sputum
Airways become even narrower
Airflow to lungs is restricted
Describe how an asthma airway would look during an attack
Tightened muscle around the airway
Inflammation and increased sputum leads to a narrowed passageway
Name some symptoms of asthma
Coughing
Dyspnoea (difficulty breathing)
Wheeze
Chest tightness
What are some triggers of asthma
Pollen Pollution Cold weather Smoking Irritants (animal hair)
Name 2 types of asthma
Exercise-induced asthma
Allergy-induced asthma
Describe the structure of the airways
Upper Respiratory Tract •Nose (mouth) •Pharynx •Larynx Lower Respiratory Tract •Trachea •Bronchi •Bronchioles •Alveoli
Name the role of the nose in the respiratory tract
Warms, humidifies and filters air (cilia)
Describe the role of the trachea in the lower respiratory tract
- Trachea “windpipe” descends from the larynx into the thorax
- Walls contains C-shaped rings of cartilage supporting the anterior and lateral aspects
- Cartilage helps to prevent tracheal collapse during pressure changes
- Trachea bifurcates (splits) at the carina
Where does the bronchi begin?
•Trachea bifurcates at the carina into the R and L main (primary) bronchi
Where does gaseous exchange occur?
Alveoli
How do the respiratory bronchioles join to the alveolar sac
Respiratory bronchioles joined to alveolar sac via alveolar duct
What is the thoracic cage comprised of?
- Ribs
- Sternum
- Thoracic vertebra
Describe typical ribs
- Pairs 2-9
- Curved bone
- Posterior end has a head which articulates with 2 vertebral bodies
- Anterior end continuous with costal cartilage which articulates with sternum
Describe atypical ribs
- Rib 1
- Flat in the horizontal plane
- Broad superior and inferior surfaces
- Articulates with the body of T1 (thoracic vertebrae) only
What are the 3 elements of the sternum?
3 elements:
•Manubrium
•Body
•Xiphoid process
What muscles work during inspiration?
- Diaphragm
* External intercostals
What muscles work during active expiration?
- Internal intercostals
- Rectus abdominis
- Transversus abdominis
- Internal and external obliques
Are expiration and inspiration active or passive?
•Inspiration is an active process requiring energy •Expiration is largely a passive process, but we occasionally actively expire too
Describe how inspiration occurs
- Controlled by autonomic nerve impulses from the respiratory centre in the medulla oblongata in the brainstem
- Nerve stimulation causes contraction of the diaphragm and the external intercostals this expands the thoracic cage and lungs
- Expansion creates a lower pressure relative to the outside of the body
- Air rushes in
Describe how relaxed expiration occurs
- Expiration is normally a passive process (i.e. requires no energy)
- Brought about by relaxation of the diaphragm and external intercostal muscles
- This allows for the elastic recoil of the lung tissue
Describe how forced expiration occurs
- Contraction of the abdominal muscles causes the abdominal contents to push up against the diaphragm – reduces the vertical diameter of the thorax
- Contraction of the internal intercostals depress the ribs and decrease space in the thorax
Where does the control of breathing occur?
respiratory control centres in the brainstem
Name the movement of gas for the movement of air from the atmosphere to alveoli
Bulk flow
•Occurs due to a pressure difference during inspiration in alveoli (lower) compared to the atmosphere (higher)
What is partial pressure measured in?
Partial pressures are measured in kilopascals (kPa) or millimetres of mercury (mmHg)
Where does gaseous exchange occur at the lungs?
Occurs at the respiratory membrane
- the alveolar air space and the blood capillaries
What characteristics of the respiratory membrane make it ideal for gaseous exchange
- Large surface area provided by the large number of lung alveoli
- Very thin membrane so small depth for diffusion (1-2000ths of a millimetre)
Name the channels that can be used to bypass the normal route of airways to the alveoli
Channels of Martin - Bronchiole-bronchiole Canals of Lambert - Bronchiole-alveolar Pores of Kohn - Alveolar-alveolar
Collateral ventilation
What is the role of the mucociliary transport system?
provides the means for drainage of secretory products and particulate matter out of the sinuses.
What type of muscle lines the airways
Airway smooth muscle spans from the trachea to bronchioles
What nervous system is responsible for controlling the airways and how do the nerves act?
Parasympathetic nervous system
The parasympathetic nerves are autonomic (involunatry)
What type of inhaler would you recommend, how does it help and when do you use it?
Reliever inhaler (blue)
- relax the muscles around the airways
- airways open wider and easier to breath
- short-acting
- use the inhaler as soon as you notice the symptoms
What tips for breathing would a physio recommend and why?
- breathe slowly through the nose, not the mouth
- keeps the air warm and moist
- less sensitive to airways
What exercise would you recommend and what are the benefits?
Walking, yoga, and swimming. Low impact aerobic exercises, preferably inside to avoid cold air
- raises HR, increases lung power and stamina, reducing breathlessness
- supports the immune system, helping to fight cold and viruses
- reduces stress by releasing endorphins.
What are some risk factors that increase your chance of asthma?
- family history
- exposure to tobacco smoke as a child
- mother smoking during pregnancy
- bronchiolitis (childhood lung infection)
What complications can asthma have on daily living?
- feel tired all the time
- stress, anxiety, depression
- lung infections
- delays in growth
- severe asthma attacks can be life-threatening
How can steroid tablets help asthma sufferers?
Taken either as:
- immediate treatment when you have an attack
OR
- used every day as a long-term treatment to prevent symptoms
What surgery can be provided and for whom?
Bronchial thermoplasty
- thin, flexible tube placed down throat, into the lungs
- heat applied to airway walls, which reduces the excess smooth muscle tissue
- allows airways to open wider
- offered for severe asthma sufferers
