Pathophsiology Flashcards
Mild Persistant
A. Symptoms >3 days a wk or more, but not daily
B. Uses SABA > 3 days a wk but not more than once a day
C. Nighttime awakenings > 3 x month (1-2x a mo. Ages 0-4years)
D. Minor limitations to normal activity
E. Lung fx normal
Moderate Persistent
A. Daily symptoms B. SABA use daily C. Nighttime awakening > 1 x wk D. Moderate limitation to normal activity E. Lung fx is less than predicted
Severe persistent
A. Symptoms throughout the day
B. SABA several times a day.
C. Nighttime awakening occur often throughput the week (more than 1/wk 0-4 yrs)
D. Extreme limitations to normal activity
E. Lung fx is reduced
Asthma definition
Asthma is a chronic, inflammatory, obstructive, non-contagious airway disease with varying levels of severity and characterized by exacerbations.
Lung Anatomy
A. Cone shaped organs
Pleural cavity boarders are diaphragm clavicles, mediastinum
C. Lobes- separated by fissures L/2 R/3 sections
D. Thin layer of visceral pleura covers lungs
Thin layer inside chest wall parietal pleura
Area between called pleural space/ cavity
Contains small amount of fluid.
Gas conducting system conducting zone
A. Trachea ends at the carina (tracheobronchial tree)
B. Bifurcated into main bronchi (2-2.5 cm ring, 10-12 cm long left and right)
C. Lobar bronchi -> segmental bronchi -> subsegmental bronchi -> continue until the smallest conducting airways, the bronchioles
D. Bronchioles have no cartilage - the outside are rapped in smooth muscle.
E. Muscle relaxes during inhale bronchodilation and tightens during exhale bronchoconstriction.
Gas exchange system
A. Respiratory bronchioles conduct air and also have areas that participate in gas exchange
B. Lead to the alveolar ducts which end in clusters of alveoli -> area for majority of gas exchange = terminal respiratory unit.
Conducting airway tissue
Mucosa- pseudostratified, ciliates columnar epithelium
A. Beneath these are basal including cilia and goblet
B. Goblet secret
Cilia clear and defend the conducting airways
Asthma Classification
Intermittent
A. Patients experiences symptoms 2 days/ week or less.
B. Uses Saba 2 days/ wk or less
C. Nighttime weakening so
Airway tissue sub mucosa
Contains the bronchial glands - the major source of respiratory tract secretions
>glands =>of secretions
Contains mast cells- excrete mediators such as histamines and leukotrienes
Histamine-> constriction of the smooth muscle->bronchospasms SOB
Leukotrienes->are bronchoconstrictors promoting inflammation and activate esinophils.
Inflammatory response
Hypersensitivity reaction. -> histamines and the leukotrienes
Smooth muscle is found from the trachea to the terminal unit
Adventitia is a layer of connective tissue that surrounds the airway. It has blood vessels, nerves, lymphatic vessels and adipose tissue
Asthma attack
Three primary changes
Bronchial smooth muscle constriction
Muscle atrophies up to 3 times the normal size
Mucosal inflammation
Hyper secretion of mucus
Infiltrated with inflammatory cells- mast, esinophils lymphocytes-> causing edema
Three types of asthma
Acute asthma
Chronic asthma status asthmaticus
Signs of status asthmaticus
Extreme difficulty breathing Little or no breath sounds Lactic acidosis Restlessness Lack of air movement Inability to speak Cyanosis sweating Accessory muscle use Pulse less paradoxus
EIA diagnosis
Exercise challenge test
Exercise should raise heart rate by 80% of maximum for 4-6 minutes
PEF or FEV1 taken before and during at 5 minute break from intervals for 20-30 minutes
A 15% decrease is reliable indicator of EIA
