CLASS 18 - Chronic Lower Respiratory Conditions - ASTHMA + COPD Flashcards
What is asthma?
Chronic inflammatory disorder of the airways
Causes airway hyper-responsniveness leading to wheezing, breathlessness, chest tightness, and cough
What are the 4 main triggers of asthma?
- infection
- allergens
- exercise
- irritants
Describe Respiratory Infections as triggers of asthma.
How can we prevent this?
Major precipitating factor of an asthma attack
- increases inflammation and hyperresponsiveness of the tracheo-bronchieal system
- can last 2-8 wks
- influenza vaccines recommended for children 6 mo and older and adults w asthma
Describe Nose + Sinus Problems as Triggers of asthma
Allergic rhinitis + nasal polyps.
Large polyps are removed.
Sinus problems are usually related to inflammation of the mucous membranes.
What is triad asthma?
Condition in which an individual has asthma, sinus inflammation with recurring nasal polyps, and sensitivity to aspirin and NSAIDs.
Describe Drugs and Food Additives as triggers of asthma. How can we treat this?
Typically occurs in people w triad asthma.
Wheezing develops in ~ 2 hrs
Occurs in people w sensitivity to salicylates (found in many foods, beverages, and flavourings).
Can be treated w beta-adrenergic blockers
Describe GERD (gastro-esophogeal reflux disease) as a trigger of asthma.
Exact mechanism is unknown, but reflux of acid could be aspirated into the lungs resulting in bronchoconstriction.
Describe air pollutants as triggers of asthma and provide examples.
Air pollutants can trigger asthma attacks.
- cigarette or wood smoke
- vehicle exhaust
- elevated ozone levels
- sulphur dioxide
- nitrogen dioxide
Describe Emotional Stress as a Trigger of Asthma
Psychological factors can worsen the disease process. Asthma attacks can trigger panic and anxiety.
Describe the process of the early-phase response of asthma. When does it occur? When does it subside?
Primarily bronchospasm.
increased mucus secretion, edema formation, increased amounts of tenacious sputum
peaks in 30-60 mins after trigger exposure
subsides in about 30-90 mins
Describe the process of the early phase response of asthma at the cellular level
Allergen enters body
B lymphocytes convert to plasma cells which release IgE antibodies.
IgE antibodies bind to mast cells which consume the allergen and present pieces of it on their surface.
Mast cell releases histamine and inflammatory mediators.
Results in bronchospasm, increased mucous secretion, edema, and increased amts of sputum
Describe the process of the late-phase response of asthma in terms of its severity, onset, duration, and treatment.
What will happen if airway inflammation is not treate or doesn’t resolve?
Can be more severe than the early-phase response.
Primarily inflammation
Peaks in 5-12 hrs, may last several hrs or days
Corticosteroids can prevent + reverse this cycle
If not treated or doesn’t resolve, may lead to irreversible lung damage.
Identify 3 factors that can result in airway obstruction.
Muscle spasm
Swollen mucosa
Mucus
What are the clinical manifestations of asthma?
When do they most often occur? How long do they last?
Unpredictable + variable
Recurrent episodes of wheezing, breathlessness, cough, and tight chest
Prolonged expiration
Particularly at night or in early morning
May be abrupt or gradual
Lasts minutes to hours.
Why might expiration be prolonged in cases of asthma? What would the inspiration:expiration ratio typically be in this case?
Ratio of 1:2, 1:3, or 1:4
Bronchospasm, edema, and mucus in bronchioles narrow the airways
Therefore air takes longer to move out.
Can wheezing be used as a method to gauge the severity of asthma?
No. Severe attacks may have no audible wheezing.
What is cough variant asthma?
Only symptom is a dry cough.
Bronchospasm is not severe enough to cause airflow obstruction.
An acute asthma attack usually reveals signs of hypoxemia. What are the signs of hypoxemia?
- restlessness
- anxiety
- inappropriate behaviour
- increased pulse and BP
- pulsus paradoxus
- respiratory rate greater than 30 breaths / minute
What is pulsus paradoxus?
Pulsus paradoxus refers to an exaggerated fall in a patient’s blood pressure during inspiration by greater than 10 mm Hg
Describe a severe acute attack as a complication of asthma. What are the common causes? What are the clinical manifestations?
Common causes include viral illnesses, ingestion of Aspirin or other NSAIDs, increases in environmental pollutants or other allergen exposure, and discontinuation of drug therapy.
Clinical manifestations are similar to those of non-severe asthma but are more serious and prolonged.
What are the more severe complications of a severe asthma attack?
- pneumothorax
- pneumomediastinum
- acute cor pulmonale w right ventricular failure
- severe respiratory muscle fatigue that leads to respiratory arrest (which can be fatal)
What is COPD?
What are its defining features?
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.
defining features are:
- irreversible airflow limitations during forced expiration due to the loss of elastic recoil
- airflow obstruction due to mucous hypersecretion, mucosal edema, and bronchospasm.
What are the 4 common characteristics of COPD?
- mucous hypersecretion
- dysfunction of cilia
- hyperinflation of lungs
- gas exchange abnormalities
What are the 5 main risk factors for COPD?
- Cigs
- Occupational chemicals and dust (air pollution)
- infection
- heredity
- aging
What is the effect of nicotine on the body?
stimulates SNS
- increases HR
- causes peripheral vasoconstriction
- increases BP and cardiac workload
What is the effect of cig smoking on the respiratory tract?
- Increases mucous production
- Hyperplasia of goblet cells
- Lost or decreased ciliary activity
What are the effects of cigarette smoking on the body’s O2 carrying capacity?
decreases it.
What is the primary process of COPD?
Inflammation.
- inhalation of noxious particles
- mediators released cause damage to lung tissue
- airways become inflamed
- parenchyma (functional tissue) of lung destroyed
The supporting structures of the lungs are destroyed as a result of COPD. What does this result in?
- air goes in easily but remains in the lungs
- bronchioles collapse
- causes barrel-chest look
Describe the changes in the bronchioles and alveoli of the lungs as a result of COPD.
Bronchioles lose their shape, become clogged w mucous
Alveolar walls destroyed, results in fewer, larger alveoli
What are the complications of COPD?
- cor pulmonale
- exacerbations of COPD
- acute respiratory failure
- depression / anxiety
What is Cor Pulmonale?
Hypertrophy of the R side of the heart
- result of pulmonary hypertension
- late manifestation of COPD
- eventually causes R sided heart failure
What are the clinical manifestations of Cor Pulmonale?
- dyspnea
- distended neck beins
- hepatomegaly with right upper quadrant tenderness
- peripheral edema
- weight gain
- ascites (fluid in abdomen)
- epigastric distress
What is an exacerbation of COPD? What are the primary causes?
A “flare up” of symptoms
Primary causes are:
- infection
- air pollution
- allergens
- irritants
- cold air
What are the causes of acute respiratory failure associated with COPD?
- exacerbations
- cor pulmonale
- discontinuation of bronchodilator or cotricosteroid medication
- sedative or opioid use
- surgery or severe, painful illness
What are the clinical menifestations of COPD?
- develops slowly
- dyspnea
- chest breathing (accessory muscle use)
- underweight
- anorexia
- chronic fatigue
- bluish-red colour of skin
What are the clinical examination findings for COPD?
- prolonged expiratory phase
- wheezes
- decreased breath sounds
- increased anterior-posterior diameter
How can pursed-lip breathing help improve symptoms of COPD?
Prolongs exhalation and prevents bronchiolar collapse and air trapping.
How can diaphragmatic breathing help improve symptoms of COPD?
Focuses on using the diaphragm instead of accessory muscles to achieve max inhalation and slow respiratory rate.
what are the 5 main goals of O2 therapy with COPD?
- reduce WOB
- maintain PAO2
- reduce workload on the heart
- reduce hematocrit
- reduce pulmonary hypertension
