EXAM3/CH20- Asthma

Question 1

what type of disorder is asthma

Answer 1

chronic inflammatory disorder

Question 2

what occurs in asthma

Answer 2

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

Question 3

asthma symptoms

Answer 3

-wheezing
-breathlessness
-chest tightness
-coughing

Question 4

when do asthma episodes typically occur

Answer 4

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

Question 5

wheezing

Answer 5

high pitched sound during inspiration + expiration

Question 6

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

Answer 6

cough

Question 7

spontaneous reversal

Answer 7

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

Question 8

disease scope of asthma

Answer 8

-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)

Question 9

when does most childhood asthma begin

Answer 9

infancy (less than 3 years of age)

Question 10

asthma pathophysiology

Answer 10

-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

Question 11

____ promote inflammation by activating ____ + ____

Answer 11

CD4 lymphocytes
eosinophils
mast cells

-all involved in the inflammatory cascade that results in bronchoconstriction

Question 12

asthma- acute process (minutes to hours)

Answer 12

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

Question 13

bronchoconstriction

Answer 13

tightening of the airways

Question 14

edematous swelling

Answer 14

the tissue itself accumulates fluid + begins to swell

Question 15

asthma- chronic process (months to years)

Answer 15

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

Question 16

what does collagen deposition do to the lungs

Answer 16

causes lung tissue to become stiffer

Question 17

hyperplasia

Answer 17

increase in cell number

Question 18

angiogenesis

Answer 18

growth of blood vessels

Question 19

what cells line the airways

Answer 19

columnar epithelial cells

Question 20

epithelial cells have ____

Answer 20

cilia

Question 21

cilia

Answer 21

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

Question 22

what do blood vessels in mucosa do

Answer 22

bring nutrients to tissue + remove waste from the cells

Question 23

how are smooth muscle cells shaped

Answer 23

spindle shaped
-can constrict to narrow the airway

Question 24

how does tissue of chronic asthmatic compare to normal

Answer 24

-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

Question 25

asthma symptoms

Answer 25

-wheezing -breathlessness -cough -chest tightness

Question 26

what can impede asthma diagnosis

Answer 26

intermittent episodes

Question 27

potential stimuli of asthma

Answer 27

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

Question 28

diagnosing asthma

Answer 28

-medical history -physical exam of the chest -spirometry

Question 29

spirometry

Answer 29

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

Question 30

FEV1

Answer 30

forced expiratory volume in 1 second

Question 31

what is the most common indicator of asthma

Answer 31

FEV1

Question 32

FVC

Answer 32

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

Question 33

FEV1/FVC

Answer 33

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

Question 34

pharmacologic challenge

Answer 34

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

Question 35

what FEV1 is consistent with asthma

Answer 35

less than 80% of predicted

Question 36

what FEV1/FVC is consistent with asthma

Answer 36

less than 65% of predicted

Question 37

other clinical assessments for diagnosing asthma

Answer 37

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

Question 38

chest roentgenogram

Answer 38

x-ray

Question 39

sputum production

Answer 39

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

Question 40

pneumothorax

Answer 40

when you get air in your chest + the lung collapses

Question 41

what can cause many of the lung symptoms we see

Answer 41

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

Question 42

what MUST be done to diagnose asthma

Answer 42

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

Question 43

exercise testing for asthma

Answer 43

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

Question 44

what type of exercise test would be done

Answer 44

symptom-limited incremental test -often times SOB stops test

Question 45

what measurements may be taken during exercise testing

Answer 45

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

Question 46

contraindications for exercise testing

Answer 46

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

Question 47

asthma treatment

Answer 47

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

Question 48

preventing EIB (exercise induced bronchoconstriction)

Answer 48

-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

Question 49

what does asthma represent

Answer 49

airway narrowing secondary to airway inflammation

Question 50

what does airway hyperresponsiveness exaggerate

Answer 50

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

Question 51

what do asthma treatment strategies focus on

Answer 51

prevention of acute episodes rather than reversal

Question 52

what is common is asthmatics

Answer 52

exercise limitation + decreased levels of fitness

Question 53

how can fitness be improved for asthmatics

Answer 53

using appropriate medication + conditioning regime