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*CLINICAL EXERCISE PHYSIOLOGY > EXAM3/CH20- Asthma > Flashcards

EXAM3/CH20- Asthma Flashcards

1
Q

what type of disorder is asthma

A

chronic inflammatory disorder

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2
Q

what occurs in asthma

A

airway hyperresponsiveness causes recurrent episodes of airflow obstruction
-if you have asthma, your airways will respond more to things like smoke, pollen, etc.
quicker + more pronounced response

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3
Q

asthma symptoms

A

-wheezing
-breathlessness
-chest tightness
-coughing

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4
Q

when do asthma episodes typically occur

A

particularly at night or in the early morning
-reversible either spontaneously or with treatment

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5
Q

wheezing

A

high pitched sound during inspiration + expiration

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6
Q

what is typically the first + last symptom to occur/resolve in an asthma attack

A

cough

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7
Q

spontaneous reversal

A

if you remove the stimulus (smoke, pollen, etc.)

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8
Q

disease scope of asthma

A

-a worldwide problem with an estimated 300 million affected
-22 million Americans affected
-5% increase per year in the world
-higher in some populations (23% of inner-city African Americans vs. 5% of Caucasians)

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9
Q

when does most childhood asthma begin

A

infancy (less than 3 years of age)

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10
Q

asthma pathophysiology

A

-host factors (innate immunity, genetics) predispose to airway hyperresponsiveness
-stimuli are environmental (airborne allergens, viral respiratory infections, cold air)
-CD4 lymphocytes promote inflammation by activating eosinophils + mast cells
-cellular interactions are regulated by a cascade of inflammatory mediators

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11
Q

____ promote inflammation by activating ____ + ____

A

CD4 lymphocytes
eosinophils
mast cells

-all involved in the inflammatory cascade that results in bronchoconstriction

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12
Q

asthma- acute process (minutes to hours)

A

-airway inflammation stimulates bronchoconstriction, mucus secretion, + edematous swelling
-these obstruct airflow causing asthma ‘attacks’ which are episodic + (usually) reversible

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13
Q

bronchoconstriction

A

tightening of the airways

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14
Q

edematous swelling

A

the tissue itself accumulates fluid + begins to swell

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15
Q

asthma- chronic process (months to years)

A

-airway epithelium is damaged
-fibrosis due to collagen deposition
-smooth muscle hypertrophy, hyperplasia
-angiogenesis

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16
Q

what does collagen deposition do to the lungs

A

causes lung tissue to become stiffer

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17
Q

hyperplasia

A

increase in cell number

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18
Q

angiogenesis

A

growth of blood vessels

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19
Q

what cells line the airways

A

columnar epithelial cells

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20
Q

epithelial cells have ____

A

cilia

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21
Q

cilia

A

little hairs that are active + beat to move mucus up + out of lungs to clear foreign material from airways

-the mucus that exists in the lungs is made by the lungs by mucus glands (see dark epithelial invagination to the left of image)
-mucus is sticky so it captures dust + other foreign matter
-the cilia will then beat the mucus out of the lungs so you can swallow it or spit it out
-“mucociliary escalator”- rids lungs of foreign matter

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22
Q

what do blood vessels in mucosa do

A

bring nutrients to tissue + remove waste from the cells

23
Q

how are smooth muscle cells shaped

A

spindle shaped
-can constrict to narrow the airway

24
Q

how does tissue of chronic asthmatic compare to normal

A

-top layer of epithelium is damaged
-much more mucus
-little dust-looking particles in mucosa that are inflammatory cells
-increased + LARGER spindle shaped smooth muscle

-baseline caliber is reduced
-thicker mucosa
-mucus obstricting airway
-small hole for air to go through

25
Q

asthma symptoms

A

-wheezing
-breathlessness
-cough
-chest tightness

26
Q

what can impede asthma diagnosis

A

intermittent episodes

27
Q

potential stimuli of asthma

A

-allergens
-seasonal rhinitis
-dust mites
-smoke
-strong fumes
-cold air
-exercise

28
Q

diagnosing asthma

A

-medical history
-physical exam of the chest
-spirometry

29
Q

spirometry

A

quantitatively measures how the lungs function
-measures the rate of flow out of a persons lungs when they make a maximal effort
-ask pt to take in as much air as they can + blow out as hard as they can for as long as they can

30
Q

FEV1

A

forced expiratory volume in 1 second

31
Q

what is the most common indicator of asthma

A

FEV1

32
Q

FVC

A

forced vital capacity
-max amount of air you can blow out

33
Q

FEV1/FVC

A

you can normalize the FEV1 based on size of person based on “forced vital capacity”

34
Q

pharmacologic challenge

A

ask person to inhale a allergen/inflammatory stimulus to see if they have a normal or exaggerated response in spirometry

35
Q

what FEV1 is consistent with asthma

A

less than 80% of predicted

36
Q

what FEV1/FVC is consistent with asthma

A

less than 65% of predicted

37
Q

other clinical assessments for diagnosing asthma

A

-chest roentgenogram (x-ray)
-sputum production
-consider other causes for symptoms (e.g., pneumonia, pneumothorax, congestive heart failure)

38
Q

chest roentgenogram

A

x-ray

39
Q

sputum production

A

we look for how much inflammatory cells the pt is producing in the sputum

40
Q

pneumothorax

A

when you get air in your chest + the lung collapses

41
Q

what can cause many of the lung symptoms we see

A

primary disease of the heart
-due to back pressure that causes fluid in the lungs

42
Q

what MUST be done to diagnose asthma

A

pulmonary function tests
-you cannot assume asthma because of other diagnoses

43
Q

exercise testing for asthma

A

used to assess a decline in exercise tolerance that is unrelated to airflow limitation
-not done to diagnose

44
Q

what type of exercise test would be done

A

symptom-limited incremental test
-often times SOB stops test

45
Q

what measurements may be taken during exercise testing

A

-oxyhemoglobin saturation
-heart rhythm (ECG)
-metabolic cart (VO2, VCO2, anaerobic threshold)

46
Q

contraindications for exercise testing

A

-acute bronchospasm
-exercise-induced bronchoconstriction (EIB)
-chest pain
-elevated shortness of breath
-severe exercise deconditioning
-orthopedic limitations

47
Q

asthma treatment

A

focus on asthma control using therapeutic interventions that minimize the frequency + severity of symptoms + are acceptable to the patient

48
Q

preventing EIB (exercise induced bronchoconstriction)

A

-a mask or scarf over the mouth/nose may be helpful to reduce cold-induced EIB
-people that don’t respond to the nonpharmacologic approach can use pharmacologic intervention prior to exercise
-exposure to cold air, low humidity, or air pollutants should be minimized
-intermittent exercise or lower-intensity sports performed in the presence of warm, humid air are generally better tolerated

49
Q

what does asthma represent

A

airway narrowing secondary to airway inflammation

50
Q

what does airway hyperresponsiveness exaggerate

A

the allergic response to environmental risk factors, exercise, + cold air

51
Q

what do asthma treatment strategies focus on

A

prevention of acute episodes rather than reversal

52
Q

what is common is asthmatics

A

exercise limitation + decreased levels of fitness

53
Q

how can fitness be improved for asthmatics

A

using appropriate medication + conditioning regime

*CLINICAL EXERCISE PHYSIOLOGY (18 decks)

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