Exam #01 - Asthma (Pathophsyiology) Flashcards
True or False - Inflammation caused recurrent episodes of asthmatic symptoms is often irreversible?
False, airway obstruction from inflammation is often reversible either spontaneously or with Tx
Define asthma
Asthma is a CHRONIC, INFLAMMATORY disorder of the airways which involves many inflammatory cells, but mostly eosinophils
What actually causes wheezing, breathlessness, chest tightness, and coughing in patients with asthma?
the inflammation
When do recurrent episodes of S/S of asthma mostly occur?
at night or in the early AM
How many people are affected with asthma in the US?
23 million
How many people die annually from asthma?
4,000
Asthma is the most common death in which specific demographic? Why?
AAM 18-25 y/o
They are either under diagnosed, untreated for particular diagnosis, or didn’t know how to use medication properly
How can pharmacists impact patients diagnosed with asthma and the healthcare system (3 things)?
- EDUCATE about disease state and meds
- VERIFY understanding of inhaler technique
- DECREASE COST, DECREASE MORTALITY
True or False - there is a strong genetic component to developing asthma?
True - positive family history is one of the factors involved in childhood onset of asthma
What (3) coexisting conditions are associated with adult onset asthma?
- severe sinusitis
- nasal polyps
- hypersensitivity to NSAIDs and/or ASA (agents that can induce adult onset asthma)
What is the #1 cause of adult onset asthma?
occupational exposure
What (2) factors are associated with childhood onset asthma?
- (+) family history of allergy and/or asthma
2. atopy (genetic susceptibility to produce IgE in response to environmental allergens
What environmental allergens associated with childhood onset asthma cause the body to produce IgE?
- tree, grass, pollen
- dust mites
- pets
List (6) agents/events that trigger asthma?
- Drugs/preservatives
- Environment (cats, cleanliness, dust mites)
- Allergens (pollen, fungus,mold, cockroach feces)
- Respiratory infections (RSV, pneumonia, flu)
- Exercise (mostly in cold, dry air)
- Occupational stimuli
DEARE O
List (5) drugs/preservatives that trigger asthma?
- non-selective B-blockers
- NSAID
- ASA
- sulfites (wines & cheeses)
- benzalkonium chloride
List (4) factors that can exacerbate asthma (but don’t actually induce asthma)?
- GERD
- Rhinitis, sinusitis
- emotions
- premenstrual period
These don’t actually cause asthma
Explain the pathophysiology of asthma?
Environmental risk factors (pollen, mold, dust mites, etc.) cause inflammation of the airways. This leads to airflow obstruction and asthma symptoms (SOB, coughing, wheezing).
Inflammation can also lead to airway hyper-responsiveness in which the airway is “ready to close at any moment” which can be brought on by precipitants like grass, pollen, etc.
Upon release of IgE, several cellular mechanisms are involved in promoting inflammation and bronchospasm. List (3) inflammatory mediator cells involved in asthma?
- Eosinophils
- Neutrophils
- Macrophages
Which inflammatory mediator cell is responsible for releasing histamine, leukotrienes, and PG’s? What effect do these inflammatory mediator cells have?
Mast cells
Release of these inflammatory mediators causes BRONCHOCONSTRICTION
Explain TH-1 and TH-2 cell imbalance in a newborn and how that affects their risk for developing asthma?
It is hypothesized that allergic asthmatic inflammation results from a TH-2 mediated mechanism and, since the T-cell population of a newborn is skewed toward TH-2 phenotype, newborns are at an increased risk to developing asthma.
TH-1 cells produce factors important for cellular defense while TH-2 cells produce cytokines that mediate allergic inflammation. TH-1 cells produce cytokines that inhibit the production of TH-2 cytokines.
What is the basic premise of the hygiene hypothesis? What factors can enhance TH-1 mediated response and shift the balance of TH production to TH-1?
Parents keep their newborn away from all germs, bacteria, and environmental stimuli and therefore their immune system develops with a susceptibility towards asthma. Keeping a newborn sheltered never challenges their immune system and TH-1 cells are not produced. Because newborn T-cell population is skewed toward TH-2 phenotype, the sheltering perpetuates an imbalanced immune system and an increased risk for developing asthma
Factors that will enhance TH-1 mediate response are:
- infection (TB, measles, Hep A)
- exposure to daycare in 1st 6 months of life
- increase exposure to infections from older siblings
What would impede the restoration of the balance between TH-1 and TH-2 cells (5 factors)?
- frequent use of antibiotics
- western lifestyle
- urban environment
- diet
- sensitization to house-dust mites and cockroaches
Give the general timeframes for immediate allergic response (IAR), late asthmatic response (LAR), and chronic asthma?
IAR - minutes
LAR - hours (6-12)
chronic - days
How does the forced expiratory volume 1 second (FEV1) change during the asthmatic response (IAR, LAR, chronic)
Within minutes (IAR) there is a large decline in FEV1, but recovers to about normal and patient feels better. During LAR there is a more gradual decline in FEV1 and then recovery. During chronic there is an up and down FEV1
What medication is effective for IAR?
bronchodilators (B-agonists)
What medication is effective for LAR?
anti-inflammatory drugs
What symptoms are associated with asthma?
- coughing, wheezing, SOB
- colds that take >10 days to get over
- hyperexpansion of the thorax
- increased nasal secretions, mucosal swelling, nasal polyps
- atopic dermatitis/eczema
True or False - if a patient is wheezing, they have asthma?
False - all that wheezes is not asthma
What (3) pulmonary function tests are used to objectively assess asthma?
- Spirometry
- Peak Expiratory Flow Rate (PEFR)
- ABG and O2 saturation
Which pulmonary function test to objectively assess asthma gives you real-time analysis of asthma and is designed for MONITORING, not diagnosis?
PEFR (Peak Expiratory Flow Rate)
Which pulmonary function test to objectively assess asthma is the best test to make an accurate DIAGNOSIS of asthma and helps determine whether there is obstruction or restriction?
Spirometry
How often should you assess a patient’s asthma using a Spirometer after initial diagnosis (assume there are no treatment changes during this time period)?
1-2 years
What significance does a spirometer have after PEF and symptoms have stabilized?
Spirometer can assess the effectiveness of treatment and whether the patient still needs therapy
Which pulmonary function test to objectively assess asthma CANNOT be used for MONITORING?
Spirometer
PEFR is the test used for monitoring and not diagnosing
Which pulmonary function test to objectively assess asthma is a measurement of the extent and severity of airflow obstruction?
Peak Expiratory Flow Rate (PEFR)
True or False - It is recommended that patients with mild persistent asthma should learn how to monitor their PEFR and use a peak flow meter at home?
False - Technically, patients with moderate-severe persistent asthma should learn. However, it wouldn’t be a bad idea for every asthma patient to learn
How can monitoring PEFR at home help an asthmatic patient?
Patient can use the PEFR to predict an exacerbation that may occur later that day or tomorrow
Counsel a patient on how to use a peak flow meter to measure PEFR?
- move indicator to bottom of numbered scale
- stand up
- take a deep breath, completely filling lungs
- place mouthpiece in your mouth and close lips around it
- DON’T put tongue in hole of the device
- blow out as hard and fast as you can in a single blow
- write down number
- repeat this process 2 more times and write down the best of the 3 attempts in asthma diary
Regarding an asthma action plan developed between healthcare professional and patient, what should an asthmatic patient’s treatment be based upon?
Peak flow zones
List the 3 peak flow zones and indicate % of PFM readings they are associated with. ALSO, indicate what action should be taken if patient has a PFM reading in that particular zone?
- Green Zone >80% of PFM best
No changes to therapy needed - Yellow Zone >50% - <50%
Increase albuterol use, add oral steroid and go to ER immediately
Which pulmonary function test to objectively assess asthma is used to assess moderate to severe attacks in the emergency room and hospitalized patients?
ABG and O2 saturation
True or False - acute inflammation is a beneficial, nonspecific response of tissues to injury and generally leads to repair and restoration of the normal structure and function?
True
Explain remodeling of the airway?
Asthma is a chronic inflammatory process of the airways followed by healing. The end result may be an altered structure referred to as a remodeling of the airways. Injured tissue is replaced by scar tissue
True or False - airway remodeling is an IRREVERSIBLE process?
True
Is there a noninvasive way to assess O2 saturation?
Yes, Pulse oximetry (infrared reading through fingernail)
If a patient has 88% sat room air (RA), and you get it to 98% with 4 LNC (liters through nasal cannula). How do you check if this patient is ready for discharge?
remove oxygen, have patient walk around room, then test O2 sat on finger. If >90%, patient can go home
Which special asthma situation involves intermittent asthma patients that have cold, dry air as significant triggers for asthma symptoms?
Exercise induced asthma (or bronchospasm) EIA or EIB
What is the recommended treatment for an allergic asthmatic that does not require treatment year long since their symptoms are seasonal?
Pretreat patient (1) month prior to start of allergic season
What (2) long acting bronchodilators were recommended for treatment of nocturnal asthma?
- Theophyline
2. Salmeterol
What ion is helpful in patients with status asthmaticus in which traditional therapy is ineffective against asthma symptoms?
Mg
