Chap 13- Asthma

Question 1

Asthma educator

Answer 1

therapists goal is to be sure that the pts and the family are cognizant of their role and functions in the care of this usually chronic and often serious condition. Serve as a “change agent”

Question 2

Today guidelines are structured around the following four components of care

Answer 2

1. assessment and monitoring of asthma 2. Patient education 3. control of factors contributing to asthma severity 4. pharmacologic treatments

Question 3

NAEPP guidelines include

Answer 3

six steps of asthma management based upon degree of asthma control,
four levels of asthma; intermittent and 3 levels of persistent: mild, moderate, severe.
Adjustment to management based upon asthma control,
Use of actions plans for children and adults are recommended

Question 4

GINA

Answer 4

Global Initiative for asthma. Gathers and disseminates asthma related info while also ensuring that a system is in place to incorporate the results of scientific investigations into asthma care

Question 5

GINA’s specific goals

Answer 5

Increase awareness of asthma and its public health consequences,
Promote identification of reasons for the increased prevalence of asthma,
Promote study of the association between asthma and the environment,
Reduce asthma morbidity and mortality,
Improve management of asthma,
Improve availability and accessibility of effective asthma therapy

Question 6

Asthma is described as a lung disorder characterized by

Answer 6

1. Reversible bronchial smooth muscle constriction, 2. Airway inflammation, 3. Increased airway responsiveness to an assortment of stimuli

Question 7

During an asthma attack the smooth muscles surrounding the small airways…

Answer 7

constrict… over time the smooth muscle layers hypertrophy and can increase to three times their normal thickness

Question 8

In asthma the airway mucosa becomes infiltrated with… and in turn…

Answer 8

eosinophils and other inflammatory cells, which in turn causes airway inflammation and mucosal edema.

Question 9

Microscopic crystals

Answer 9

Charcot-Leyden crystals

Question 10

Charcot-Leyden crystals are formed

Answer 10

from breakdown of eosinophils in pts with allergic asthma. May be as large as 50um in length

Question 11

The goblet cells… and the bronchial mucous glands….

Answer 11

Goblet cells proliferate and the bronchial mucous glands enlarge. The airways become filled with thick, whitish, tenacious mucus.

Question 12

When airways become filled with thick, whitish, tenacious mucous

Answer 12

Extensive mucous plugging and atelectasis may develop

Question 13

As a result of smooth muscle constriction, bronchial mucosal edema, and excessive bronchial secretions,

Answer 13

airtrapping and alveolar hyperinflation develop

Question 14

Chronic inflammation develops over time, these anatomic alterations become…

Answer 14

irreversible, resulting in loss of airway caliber. In addition, the cilia are often damaged, and the basement membrane of the mucosa may become thicker than normal (fibrosis)

Question 15

Remodeling

Answer 15

Cilia damaged, and the basement membrane of the mucosa may become thicker than normal (fibrosis)- remarkable feature of bronchial asthma (does not occur in mild to moderate cases)

Question 16

The major pathologic or structural changes observed during an asthmatic episode are as follows

Answer 16

• Smooth muscle constriction of bronchial airways (bronchospasm),
• Excessive production of thick, whitish bronchial secretions,
• Mucous plugging,
• Hyperinflation of alveoli (air trapping),
• In severe cases, atelectasis caused by mucous plugging,
• Bronchial wall inflammation leading to fibrosis (in severe cases, caused by remodeling)

Question 17

Ratio of children/ adults with asthma

Answer 17

1 in 11 children, 1 in 12 adults. Estimated that 25.7 million people in US suffer from asthma

Question 18

Asthma is nearly twice as prevalent in young___ as young____, in the adults, however, asthma is more common in ___ then ___

Answer 18

Young boys over girls, and women over men

Question 19

Group of people that account for the disease

Answer 19

Low income and middle income countries account for more than 80% of the mortality.

Question 20

Asthma authorities are not in full agreement as to how the risk factors for asthma should be categorized but they are…

Answer 20

1. Host factors- which are primarily genetic 2. Environmental factors- that trigger the clinical manifestations of (extrinsic) asthma, or a combination of both

Question 21

Asthma severity in boys generally peaks around age and lessens dramatically during ___

Answer 21

peaks; 5-7 years and lessens dramatically during puberty. Many girls experience the onset of asthma during puberty, in adulthood the prevalence of asthma is greater in women than in men

Question 22

Host factors include

Answer 22

Genetics, Obesity, and sex and gender

Question 23

Environmental factors include

Answer 23

Allergens- outdoor and indoor air pollution, infections, Occupational sensitizers, tobacco smoke, diet

Question 24

Allergens relation to indoor pollutants, such as

Answer 24

smoke and fumes from gas and biomass fuels used for heating and cooling, molds, and cockroach infestation

Question 25

Infections such as

Answer 25

bacteria infections may cause asthma, but more likely to contribute are viral upper and lower airway infections

Question 26

Occupational sensitizers is defined as

Answer 26

asthma caused by exposure to an agent encountered in the work environment. cause 1 to 10 cases of asthma amoung adults of working age. Examples of farming, painting, cleaning, and plastic manufactures

Question 27

Infants of smoking parents are __ times more likely to develop wheezing illnesses in the first year of life

Answer 27

4

Question 28

diet- Studies have also indicated that certain characteristics of western diets, such as the following, have been associated with asthma

Answer 28

- Increased use of processed foods, - Decreased antioxidants (in the form of fruits and veggies) - Increased n-6 polyunsaturated fatty acid, - Decreased n-3 polyunsaturated fatty acid

Question 29

Drugs-

Answer 29

Asthma exacerbations are associated with the ingestion of aspirin and other nonsteroidal antiinflammatory drugs. It is estimated that as much as 20% of the asthmatic population may be sensitive to aspirin. -Beta-blocking drugs administered orally, or intraocular medications for glaucoma, are also associated with asthma

Question 30

About 5% of the asthmatic population is sensitive to foods and drinks that contain....

Answer 30

sulfites

Question 31

Other Risk factors

Answer 31

Drugs, Food additives and preservatives, Exercise-induced bronchoconstriction, Gastroesophageal reflux, Sleep (nocturnal asthma), Emotional stress, Perimenstrual asthma, Allergic bronchopulmonary aspergillosis

Question 32

GERD

Answer 32

Gastroesophageal reflux disease - pt may complain of burning, substernal pain, belching, and a bitter, acid taste, particularly when lying down.

Question 33

Diagnosis of asthma in early childhood is based primarily on the

Answer 33

assessment of the childs symptoms and physical findings--and good clinical judgement. In the older child and adult, a complete history and physical examination- along with the demonstration of reversible and variable air flow obstruction. In elderly patient, asthma is often undiagnosed because of the presence of comorbid diseases that complicate the diagnosis

Question 34

Diagnosis of asthma is often missed in the patient who acquires asthma in

Answer 34

the workplace. Form called occupational asthma. Can be misdiagnosed as COPD

Question 35

Signs and symptoms that should increase the suspicion of asthma, these include___ and a history of any of the following

Answer 35

``` WHEEZES -Recurrent cough -Recurrent wheeze -Recurrent difficult breathing -Recurrent chest tightness. Other indicators are the occurrence or worsening of symptoms at night or in a seasonal pattern. ```

Question 36

Symptoms like the presence of

Answer 36

eczema, hay fever, or a family history of asthma or atopic disease may also be an indicator.

Question 37

Another sign is if an individual has colds that "go to the chest" or that take more than ___ days to clear up

Answer 37

10 days

Question 38

Diagnostic and Monitoring tests for asthma

Answer 38

Over pts 5 years of age: FEV1, FEV1/FVC ratio, and peak expiratory flow rate (PERF). These testss measure the severity, reversibility, and variability of air flow limitations

Question 39

An increase in FEV1 of > __% (or > __mL) after administration of a bronchodilator suggests

Answer 39

>12% (or >200mL) suggests reversible air flow limitation consistent with asthma

Question 40

Normally FEV1/FVC ratio is

Answer 40

greater than 0.75 to 0.80, any value less than these values indicate air flow limitation, and asthma should be suspected

Question 41

Other diagnostic tests for asthma

Answer 41

Measurement of airway responsiveness to inhaled methacholine or histamine, or an indirect challenge test to inhaled mannitol, or an exercise or cold air challenge may be useful in confirming a diagnosis of asthma

Question 42

Other diagnostic tests can only be performed when the patient has an FEV1

Answer 42

of 80% or greater, to avoid electively inducing significant asthma symptoms in a compromised patient.

Question 43

A helpful method in confirming the diagnosis of asthma in children 5 years or younger is a trial of treatment with

Answer 43

short acting bronchodilators and inhaled glucocorticosteroids. A marked clinical improvement during the treatment and deterioration when the treatment is stopped supports the diagnosis of asthma.

Question 44

During an asthmatic episode, the smooth muscles of the bronchi may hypertrophy as much as

Answer 44

three times normal thickness

Question 45

Asthma is associated with which of the following

Answer 45

Increase in goblet cells, Damage to cilia and deduced mucous clearance, Increase in bronchial gland size

Question 46

Which of the following have gained a widespread acceptance for assessing and monitoring a pts air flow limitation

Answer 46

q 3