chapter 31 obstructive pulmonary diseases - week 2

Question 1

what is asthma

Answer 1

Asthma is a chronic inflammatory lung disorder of the airways that results in
recurrent episodes of airflow obstruction, but is usually reversible. Inflammation
causes varying degrees of obstruction in the airways, which leads to recurrent
episodes of wheezing, breathlessness, sensation of chest tightness, and cough,
particularly at night and in the early morning

Exposure to allergens or irritants initiates an inflammatory cascade involving multiple
cell types, mediators, and chemokines. Typically, there are two possible types of
asthmatic responses to stimuli: an early-phase response and a late-phase response.

Question 2

triggers for asthma

Answer 2

o Allergic asthma may be related to allergens, such as dust, pollen, grasses, mites,
roaches, moulds, animal dander, or latex.

o Asthma that is induced or exacerbated during physical exertion is called exerciseinduced asthma (EIA) or exercise-induced bronchospasm (EIB). Typically, this
type of asthma occurs after vigorous exercise, not during it.

o Respiratory infections (particularly viral) are the major precipitating factor of an
acute asthma attack.

o Some patients with asthma have chronic sinus and nasal problems. Nasal
problems include allergic rhinitis, either seasonal or perennial, and nasal polyps.

o Sensitivity to specific drugs (e.g., Aspirin and other NSAIDS) may occur in some
asthmatic persons, especially those with nasal polyps and sinusitis, resulting in an
asthma episode.

o Tartrazine (yellow dye no. 5, found in many foods) and sulphites (e.g., sodium
metabisulphite), widely used in the food and pharmaceutical industries as
preservatives and sanitizing agents can precipitate asthma symptoms. Sulphites
are commonly found in fruits, beer, and wine and are used extensively in salad
bars to protect vegetables from oxidation.

o Gastroesophageal reflux disease (GERD) can also trigger asthma.

o Various air pollutants, cigarette or wood smoke, vehicle exhaust, diesel
particulate, elevated ozone levels, sulphur dioxide, and nitrogen dioxide can
trigger asthma attacks.

o Physiological stress that elicits emotional responses such as crying, laughing,
anger, and fear can lead to hyperventilation and hypocapnia, which can cause
airway narrowing.

o Occupational asthma occurs after exposure to agents of the workplace. These
agents are diverse and include wood dusts, laundry detergents, metal salts,
chemicals, paints, solvents, and plastics.

Question 3

what is the hallmarks of asthma

Answer 3

airway inflammation and airway hyper-responsiveness

The degree of bronchoconstriction is related to the degrees of airway inflammation,
airway hyper-responsiveness, and exposure to endogenous and exogenous triggers
(e.g., infections, allergens, histamine, and other cell mediators)

Question 4

symptoms of asthma

Answer 4

a are wheezing, cough, dyspnea,
and chest tightness after exposure to a precipitating factor or trigger. Expiration may
be prolonged.

Question 5

cough variant asthma

Answer 5

In some patients with asthma, cough is the only symptom, which is termed cough
variant asthma

Question 6

how is the severity of asthma determined

Answer 6

The severity of asthma is determined from the frequency and duration of symptoms,
the presence of persistent airflow limitation, and the medication required to maintain
control

Question 7

what are comlications that can arise from severe acute asthma

Answer 7

Severe acute asthma can result in complications such as pneumothorax,
pneumomediastinum, acute cor pulmonale with right ventricular failure, and severe
respiratory muscle fatigue that leads to respiratory arrest (which can be fatal).

Question 8

two features to be considered during assessment/diagonsis of asthma

Answer 8

• Two main features must be considered in the diagnosis of asthma: symptoms and
  variable airflow obstruction. A detailed history is important in determining whether a
  person has had previous attacks of a similar nature, often precipitated by a known
  cause or trigger.

Question 9

how is asthma confirmed

Answer 9

clinically suspected asthma
should be confirmed with objective lung measurements that demonstrate postbronchodilator reversible obstruction, variable airflow limitation over time, or airway
hyper-responsiveness. Spirometry is the preferred test for diagnosing asthma;
alternative lung testing includes variations in PEFR and bronchoprovocative
challenge testing

Question 10

patient education for asthma

Answer 10

Patient education remains the cornerstone of asthma management and should be
carried out by health care providers providing asthma care. Several components
enable successful management of asthma:
(1) establishment of a confirmed diagnosis
through the use of objective measures;
(2) development of a partnership between
health care providers and the patients and families affected by asthma;
(3) limited exposure to triggers;
(4) education of patients;
(5) appropriate pharmacotherapy;
(6) continuous assessment and monitoring of asthma control and severity;
(7) implementation of a written action plan; and (8) ensuring regular follow-up.

Question 11

medications used for asthma

Answer 11

Medications are divided into two general classifications:
(1) relievers (“rescue”
medications used intermittently as required to ease asthma symptoms) and
(2) controllers (maintenance therapy used on a daily basis, typically twice a day).

o Because chronic inflammation is a primary component of asthma, corticosteroids,
which suppress the inflammatory response, are the most potent and effective antiinflammatory medication currently available to treat asthma.
o Mast cell stabilizers are nonsteroidal anti-inflammatory drugs that inhibit the IgEmediated release of inflammatory mediators from mast cells and suppress other
inflammatory cells (e.g., eosinophils).
o The use of leukotriene modifiers can successfully be used as add-on therapy to
reduce (not substitute for) the doses of inhaled corticosteroids.
o Short-acting inhaled β2-adrenergic agonists are the most effective drugs for
relieving acute bronchospasm. They are also used for acute exacerbations of
asthma.
o Methylxanthine (theophylline) preparations are less effective long-term control
bronchodilators than β2-adrenergic agonists.
o Anticholinergic agents (e.g., ipratropium [Atrovent], tiotropium [Spiriva]) block
the bronchoconstricting influence of the parasympathetic nervous system.

One of the major factors for determining success in asthma management is the correct
administration of drugs.

Inhalation devices include metered-dose inhalers (with or without spacers), dry
powder inhalers, and wet nebulizers.

Question 12

what is the goal with asthma treatment

Answer 12

A goal in asthma care is to maximize the ability of the patient to safely manage acute
asthma episodes via an asthma action plan developed in conjunction with the health
care provider. An important nursing goal during an acute attack is to decrease the
patient’s sense of panic.
* Written asthma action plans should be developed together with the patient and family,
especially for those with moderate or severe persistent asthma or a history of severe
exacerbations

Question 13

copd

Answer 13

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable
disease state characterized by airflow limitation that is not fully reversible. The
airflow limitation is usually progressive and associated with an abnormal
inflammatory response of the lungs to noxious particles or gases, primarily caused by
cigarette smoking

Question 14

copd

Answer 14

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable
disease state characterized by airflow limitation that is not fully reversible. The
airflow limitation is usually progressive and associated with an abnormal
inflammatory response of the lungs to noxious particles or gases, primarily caused by
cigarette smoking

In addition to cigarette smoke, occupational chemicals, air pollution, infections, and
heredity are risk factors for developing COPD. Severe recurring respiratory tract
infections in childhood have been associated with reduced lung function and
increased respiratory symptoms in adulthood.

Question 15

symptoma of copd

Answer 15

Cardinal symptoms experienced by patients with COPD are dyspnea, difficulty
breathing, or shortness of breath and limitations in activity. Symptoms are usually
insidious in onset and progressive. Dyspnea is the subjective experience of shortness
of breath and is the most disabling symptom in COPD

Weight loss and malnutrition are commonly seen in the patient with severe
emphysematous COPD. The client with COPD should try to keep the body mass
index (BMI) between 21 and 25 kg/m

Question 16

emphysema

Answer 16

Emphysema describes only one pathological change present in COPD: destruction of
the alveoli.

Aging results in changes in the lung structure, the thoracic cage, and the respiratory
muscles, and as people age there is gradual loss of the elastic recoil of the lung.
Therefore, some degree of emphysema is common in the lungs of the older person,
even a nonsmoker.

Question 17

chronic bronchitis

Answer 17

Chronic bronchitis, the presence of chronic productive cough for 3 months in 2
successive years, is a useful epidemiological term but does not convey how airway
limitation severely affects morbidity and mortality in patients with COPD.

Question 18

what is the name of the disorder that is the only known geneti cabonormality that leads to COPD

Answer 18

α1-Antitrypsin (AAT) deficiency, an autosomal recessive disorder, is currently the
only known genetic abnormality that leads to COPD

Question 19

what is the name of the disorder that is the only known geneti cabonormality that leads to COPD

Answer 19

α1-Antitrypsin (AAT) deficiency, an autosomal recessive disorder, is currently the
only known genetic abnormality that leads to COPD

Question 20

how to diagonsis copd

Answer 20

A diagnosis of COPD should be considered in any patient who has symptoms of
cough, sputum production, or dyspnea, and/or a history of exposure of risk factors for
the disease. An intermittent cough, which is the earliest symptom, usually occurs in
the morning with the expectoration of small amounts of sticky mucus resulting from
bouts of coughing.

COPD can be classified as mild, moderate, severe, and very severe.

The diagnosis of COPD is confirmed by pulmonary function tests. Goals of the
diagnostic workup are to confirm the diagnosis of COPD via spirometry, evaluate the
severity of the disease, and determine the impact of disease on the patient’s quality of
life. When the postbronchodilator FEV1/FVC ratio is less than 70%, it confirms the
presence of airway obstruction.

Question 21

complications of copd

Answer 21

failure, resulting from pulmonary hypertension, and is a late manifestation of
COPD with poor prognosis.

o An acute exacerbation of COPD (AECOPD) is defined as a sustained worsening
of respiratory symptoms, such as dyspnea, cough, or sputum production that leads
to an increased use of maintenance medications or supplementation with
additional medications. These flares require changes in management.

o Patients with severe COPD who have acute exacerbations are at risk for the
development of acute respiratory failure.

o Anxiety and depression often accompany COPD. Proper screening for anxiety
and depression and assessment of coping strategies and supports by health care
providers are needed to reduce the intensity of these symptoms and improve
quality of life.

Question 22

primary goals of treating a copd patient

Answer 22

The primary goals of care for the COPD patient are to
(1) prevent disease progression
(smoking cessation),
(2) reduce the frequency and severity of exacerbations,
(3)alleviate breathlessness and other respiratory symptoms,
(4) improve exercisetolerance and daily activity,
(5) treat exacerbations and complications of the disease,
(6) improve health status and quality of life, and (7) reduce the risk of mortality.

Cessation of cigarette smoking in all stages of COPD is the single most effective
intervention to reduce the risk of developing COPD and stop the progression of the
disease.

Question 23

what medication are most common for copd

Answer 23

Bronchodilators are the mainstay of pharmacological therapy for COPD. Although
patients with COPD do not respond as dramatically as those with asthma to
bronchodilator therapy, a reduction in dyspnea and an increase in FEV1 are usually
achieved

Inhaled corticosteroids in combination with a long-acting β2 agonist have been found
to reduce the frequency of exacerbations and to improve lung function and health
status. Phosphodiesterase 4 inhibitor, roflumilast (Daxas) is indicated as add-on
therapy with bronchodilators for the maintenance of COPD in patients with chronic
cough and sputum and frequent exacerbations.

Question 24

how does oxygen therapy help copd

Answer 24

Oxygen therapy is frequently used in the treatment of COPD and other problems
associated with hypoxemia. Long-term O2 therapy improves survival in hypoxemic
patients.
o O2 delivery systems are classified as low- or high-flow systems. Most methods of
O2 administration are low-flow devices that deliver O2 in concentrations that vary
with the person’s respiratory pattern.
o Dry O2 has an irritating effect on mucous membranes and dries secretions.
Therefore, it is important that O2 be humidified when administered, either by
humidification or nebulization.

Question 25

two different surgical produres that have been used in severe copd

Answer 25

o Lung volume reduction surgery is used to reduce the size of the lungs by
removing about 20% to 35% of the most diseased lung tissue so the remaining
healthy lung tissue can perform better.
o In selected patients with very advanced COPD, lung transplantation improves
functional capacity and enhances quality of life.

Question 26

pulmonary rehabilitation programs (PRPs)

Answer 26

Pulmonary rehabilitation programs (PRPs) are used to optimize the functional status
of patients with COPD—as well as their quality of life, experience of dyspnea,
exercise endurance, psychosocial functioning, and overall autonomy.

Specific components of a PRP can include exercise conditioning (aerobic and upper
and lower body conditioning), breathing exercises, energy conservation, nutrition,
smoking cessation, environmental factors, health promotion, patient education and
self-management, psychological support, psychological counselling, and vocational
rehabilitation.
o Pursed-lip breathing is a technique that is used to prolong exhalation, prevent
bronchiolar collapse and air trapping, and assist with dyspnea. Exhalation should
be at least three times longer than inhalation.
o The main goals of effective coughing are to conserve energy, reduce fatigue, and
facilitate removal of secretions. Huff coughing is an effective technique that the
patient can be easily taught.