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LAM Respiratory > Cough 2 > Flashcards

Cough 2 Flashcards

1
Q

Which one (IAD or RAO) have the following characteristics:

    • Occasional cough
  • -Poor performance
    • No increase RR
A

IAD (Inflammatory Airway Dz)

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2
Q

Which one (IAD or RAO) have the following characteristics:

    • Regular to frequency cough
    • exercise intolerance
    • increased respiratory effort
A

RAO

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3
Q

What age group is affected by IAD & RAO

    • IAD =
    • RAO=
A

Age groups
IAD= young -middle aged (any age)
RADO = >7 yo

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4
Q

Which disease can be controlled but NOT cured (IAD or RAO)

A

RAO

– last for weeks, improve with strict environmental control or tx

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5
Q

Which disease often improves spontaneously or with minor tx (IAD or RAO)

A

IAD

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6
Q

Which disease is often seasonal (pollens or allergens)

A

RAO

– IAD is not seasonal = can seem seasonal if the horse only races once a year

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7
Q

Which disease is associated with the following (IAD or RAO)

    • Airway hyper-responsiveness
    • Ariway obstruction
    • Airway remodeling
A

Both RAO and IAD:

    • Airway hyper-responsiveness
    • Airway obstruction
    • Airway remodeling
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8
Q

What did RAO used to be referred to:

A

COPD

    • no longer called COPD
    • Preferred name is RAO or “Heaves”
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9
Q

T/F: both IAD and RAO are considered equine asthma

A

True

– both IAD and RAO represent a spectrum of chronic inflammatory dz of airway.

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10
Q

Term to describe mild (IAD) to severe (RAO) airway disease

A

Equine Asthma

    • IAD does not necessarily develop to RAO over time
  • -No evidence of mild case (IAD) will increase the risk of developing RAO
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11
Q

IAD is most noticeable in what type of horses

A

Athletic horses

  • -IAD most noticeable in athletic horses
  • -Main contributor is the high levels of particulates in the environment (viral, bacterial, or genetic predisposition).
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12
Q

The main contributor to IAD is the high levels of:

A

High levels of particulates in the environment – Viral / Bacteria/ Genetic predisposition.

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13
Q

For IAD, elevated _____ cells in BAL suggest a degree of allergic response

A

Mast cells

– no evidence of IgE involvement in IAD

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14
Q

If all other test seem normal but the horse still has poor performance then consider what disease

A

IAD

– run BAL to see mast cells

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15
Q

Diagnostic of choice for IAD

A

BAL – to see mast cells

or pulmonary function test

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16
Q

T/F: For IAD, You want to have surfactant in the BAL sample bc I will make a buffer coat of white foamy bubbles which proves you are deep all the way to the alveoli

A

True

  • -Neutrophils >10%
    • Mast cells >5%
  • -Eosinophils >5%
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17
Q

What is the test that evaluates if the animal has adequate airflow

A

Pulmonary function test

    • Oscillometry or plethysmography
    • determents: Pressure, Volume and flow
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18
Q

What test quantifies the hyperresponsiveness of the airway

A

Histamine Bronchoprovocation

    • Get baseline first
    • take histamine and nebulize the horse causing bronchoconstriction
    • this quantifies the hyperresponsiveness of the airway by increasing the amount to see how reactive they are.
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19
Q

Common condition in mature horses of the Northern hemisphere

A

RAO

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20
Q

What is the inflammatory condition of the lower respiratory tract that is caused by an environmental source

A

RAO

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21
Q

Which disease (IAD or RAO) is associated with excessive mucus production & reversible bronchospasm (bronchoconstriction)

A

RAO characterized by:

  1. Excessive mucus production
  2. Neutrophil accumulation
  3. Bronchial hyperreactivity
  4. Reversible bronchospasm (bronchoconstriction)
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22
Q

What type is RAO associated with:

A

Wet and cool climate = RAO

– rarely occurs in warm dry areas

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23
Q

RAO usually occurs during poor ventilation (dusty, moldy hay (round bales), dust, pollen and mold exposure). When does exposure occur:

A

Exposure occurring 1 to 3 months previously

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24
Q

Key to diagnosis of ROA:

A

Nostril flaring and a markedly accentuated EXPIRATORY effort (heave)

other signs:

    • Nasal Discharge may not be evident
  • -Tachypnea (resp rate exceed 40 breaths/min)
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25
Q

What disease is associated with the following clinical signs:

    • Anxious facial expression
    • reluctance to move
    • inappetence & wt loss occur in severely affected horses
  • -HEAVE LINES
A

ROA

26
Q

The main complaint from owners with a ROA horse

A

– abnormal breathing effort

27
Q

What can be used during physical exam to hear abnormal lung sounds in a ROA case

A

Rebreathing bag

– in mildly affected horses, crackles or high pitched expiratory wheezes may be detected.

28
Q

Exposure to moldy hay, endotoxins or fungal spores result in:

A

Airway Neutrophilia

    • inflammation
    • bronchoconstriction
  • -mucus accumulation
  • -airway thickening
  • -gas exchange impaired
29
Q

Inflammation in ROA causes epithelial cell destruction resulting in:

A

Delayed clearance of the mucus

– controversy of TH1 and TH2 inflammatory rxn

30
Q

What is the result of peribronchial infiltrate and epithelial metaplasia

A

Airway thickening

    • goblet cells will be growing and be hyperplastic and secreting more mucus.
    • the contraction of smooth muscle in the airways
  • -Bronchoconstriction is reversible bc no fibrous tissue
31
Q

In bronchoconstriction, what are the inflammatory mediators that are released

A

Histamine
Serotonin
Eicosanoids
Leukotrienes

32
Q

Which inflammatory mediators are responsible augmenting the released of acetycholine from parasympathetic nerves

A

Histamine & Serotonin augment the release of acetycholine from parasympathetic nerves.

– Acetycholine activates muscarinic receptors on smooth muscle resulting in bronchoconstriction

33
Q

What activates muscarinic receptors on smooth muscle resulting in bronchoconstriction

A

Acetycholine

34
Q

Histologic ROA changes are:

A

Histologic Histologic changes:

  1. Goblet cell hyperplasia
  2. Epithelial cell damage
  3. Bronchial & bronchiolar epithelial cell hyperplasia
  4. Smooth muscle hypertrophy & hyperplasia
  5. Collagen deposition
  6. Overinflation of the alveoli
35
Q

T/F: Both IAD & RAO need hematology to rule out other conditions

A

True

36
Q

What type of inflammation is viewed on cytological analysis of ROA

A

Suppurative nonseptic inflammation

  • -Neutrophilia >25% with decrease lymphocyte and alveolar macrophages
  • -tracheal mucus accumulation
37
Q

What is the % neutrophilia associated with IAD & RAO

A 
IAD = >10% 
ROA= >25%
38
Q

Which of the following diseases are associated with a HIGH neutrophilia with no affect on eosinophils or mast cells

A

ROA – >25% with decreased lymphocyte & alveolar macrophages

IAD – >10% Neutrophil, Mast cells >5%, Eosinophils >5%

39
Q

What is expected to see on a ROA patient on endoscopic examination:

A

Distal airways are EDEMATOUS and INFLAMED. Airways easily collapse during expiration
– demonstrates tracheobronchial secretions that originate from bronchial segments

40
Q

What diagnostic test can confirm thoracic effusion

A

Ultrasound

41
Q

In diagnosing ROA, what is the hay challenge test

A

Hay challenge test = horses are exposed to moldy hay which triggers an airway obstruction within hours

42
Q

Most important aspect in treating RAO:

A

Environmental management is the most important aspect for treatment

    • Well-ventilated stall
  • -adequate bedding
    • minimized dust
  • -pellet feed, hay cubes, soak hay in water
43
Q

Adjunct therapy for ROA treatment:

A

Polyunsaturated omega 3 FA combine with low dust diet

44
Q

3 main classes of bronchodilators:
1.
2.
3.

A

3 main classes of bronchodilators:

  1. Anticholinergics (muscarinic antagonist)
  2. B2 agonist
  3. Phosphodiesterase (PDE) inhibitors
45
Q

Name the 2 anticholinergics that block the smooth muscle constricting effects of acetycholine

A

Atropine & Ipratropium

– Atropines short duration of action (2hours)

46
Q

Which anticholinergic is used in emergency for quick relief to stabilize the horse

A

Atropine!

    • short duration of action (2 hrs)
    • undesirable sides effects: mydriasis, ileus, tachycardia, dry airway secretions
47
Q

Out of the 2 anticholinergics used, which one has less side effects:

A

Ipratropium bromide

    • onset of action of inhaled ipratropium is 30 minutes and the duration effect ranges from 4-6 hrs.
    • powder form may be nebulized
    • poorly absorbed by the respiratory or GI tract, minimal systemic effects.
48
Q 
What are the beta 2 adrenergic agonists used to relax smooth muscle by increasing the intracellular levels of cAMP:
1.
2.
3.
4.
5.
A

Beta 2 adrenergic agonists- relax smooth muscle

  1. Clenbuterol
  2. Albuterol
  3. Fenoterol
  4. Pirbuterol
  5. Salmeterol
49
Q

Which beta 2 adrenergic agonist can be used as a nebulizer drug:

A

Albuterol

50
Q

T/F: If the horse is on Clenbuterol and no clinical improvement is not observed within 3 days, the horse should be taken off Clenbuterol.

A

FALSE

    • If clinical improvement is not observed with 3 days, increase dose for another 3 days.
    • the effective dose of clenbuterol may vary among horses.
51
Q

T/F: Clenbuterol relaxes smooth muscle and exerts an anti-inflammatory effect

A

True

52
Q

Anxiety, shivering, sweating, and tachycardia are all adverse side effects of CLenbuterol. How can this be avoided?

A

Adverse side effects are minimized when Clenbuterol is increased in a stepwise manner.

53
Q

What is the MOA of phosphodiesterase inhibitors:

A

–PDE inhibit the breakdown of intracellulae cAMP, maintaining smooth muscle relaxation.

54
Q

Name 2 phosphodiesterase Inhibitors:

A

Aminophylline
Pentoxifylline

– well absorbed PO

55
Q

T/F: Phosphodiesterase inhibitors have similar effects of atropine while lacking adverse side effects.

A

True

– PDE have bronchodilator effect but not enough to save the horse (ADJUNCT THERAPY)

56
Q

T/F: Oral prednisone is the best treatment for a horse with ROA

A

FALSE!!!!!!!! ==> On exam

– Oral prenisone is therapeutic failure bc it is NOT metabolized in horses.

57
Q

Why is oral prednisone a therapeutic failure:

A

Prednisone has poor absorption and the lack of conversion to the active metabolite PREDNISOLONE *****

58
Q

What medicine is used to cure an ROA horse

A

CORTICOSTEROIDS

  1. Dexamethasone
  2. Prednisolone
59
Q

Which corticosteroid produces a significant improvement in lung function parameters within 6 hours of treatment, with peak effects occurring 24 hours later.

A

Dexamethasone oral

–other corticosteroids: triamcinolone acetonide & Isoflupredone

60
Q

Is it best to administer the glucocorticoid or bronchodilator first?

A

Bronchodilator FIRST – improves glucocorticoid deposition

61
Q

What is used for maximal therapeutic effects for ROA treatment

A

inhaled steroids in conjunction with inhaled bronchodilators

–Ex. steroids + albuterol = great combo for foals

62
Q

T/F: In metered dose inhalers, the inhaler system needs a spacer to optimize the drug particle size to be deposited in the lower respiratory tract.

A

True

LAM Respiratory (6 decks)

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