PULMO-Asthma Flashcards
Asthma
narrowing (obstruction/reacive) of bronchial airways
bronchoconstricat, hyperreactive= dyspna
reversible
Prevlaance
8-11% us population
1/2 chidren. Inc AA- leave in polluted city, mold, old buildings, fast food, stressful, close prox,
<10y male to female 2:1
>10y female to male 2:1
Risk factors
Rarely truth behind growing out of ashtma
many adults have asthma excbaeration w/ illness
Smoking parents
Work place bacteria
Extrinsic Atopic Asthma
Pt response to IgE antibody. inc IGE Atopy= common triad of eczema, allergy, asthma FH age <30y Seasonal sx Males
Intrinsic
No Atopy No triggers Asthma w/ URI Older age onset No FH *Normal serum IgE No repsponse to bronci changes *less respons to therapy persistent and progressive
Pahtophysiology
Breathing throough a straw c/c
Narrowing of airway
Inflammotory-mast cells, baophil eosnphils, reacte and, vessels enlarge, mucus produce w/ WBC, narrow
Inc. resisetance
Aireway edema
Pt breath at high volume to keep airway open, hyperinflation
Bronchoconstriction
Exercise Allergens Pollutants URI Aerosols GERD Food persever-sulfates Aspirin, NSaids Dry, cold air
Pathophysiology
Inflammatory mediators:
cause bronchial smooth muscle contraction resulting in airway edema, inflammation and narrowing
increase mucus production- edema and mucus plugging leads to narrowing of peripheral airways causing increased resistance to inspiratory and expiratory air flow and trapping of air
patient must breathe at high volumes to keep the airway open, causing hyperinflation
What is the Dx of a patient who has episodic bronchoconstriction that follows exercise?
Exercise Induced Bronchoconstriction (EIB)
Intermittent paroxysms of cough
chest tightness
wheezing
dyspnea
Cough variant asthma
May or may not report associated provoking factors
slowly progressive over a period of hours or days
Describe a patient with Asthma: Clinical Characteristics
Cough variant asthma
cough may be sole presenting sx of asthma, in pts with or without h/o asthma;
may progress to include wheezing, SOB;
must be considered in pts with subacute or chronic cough
Describe Asthma Physical Exam
Tachypnea
Tachycardia
SOB
diffuse inspiratory and/or expiratory wheezes
Use of accessory muscles
Hyperinflation,
HYPER-resonance
Position helps indicate severity
mild – supine
moderate – sitting
severe – tripod
Between exacerbations PE should be normal
Look for evidence of triggers (allergic rhinitis, URI, sinusitis)
WBCs maybe elevated d/t: prednisone, infection, received epinephrine, or stress
ASX-lab normal – may have elevated serum IgE with atopic disease
Eosinophilia: useful in diagnosing asthma in NEW onset wheezing reversible by β-2 agonists
Pulse oximetry: baseline & measure desaturation with exertion; acute exacerbations
Peak Expiratory Flow Rate (PEFR) -Baseline gives indication of severity, or control of asthma
document response to tx
Maximal flow rate achieved in the FVC
Describe Diagnostics of Asthma Pt
diffusing capacity of the lungs for carbon monoxide; measures ability of lungs to transfer gas from inhaled air to RBC in pulmonary capillaries; helps narrow ddx of lung disease
Quantitation of diffusing capacity of CO (DLCO
Forced Vital Capacity: FVC
Volume of gas that can be forcefully expelled from the lungs after maximal inspiration
Spirometry
FEV1
Volume expelled in the first second of the FVC
Forced Expiratory Volume:
TLC
Volume of gas in lungs after a maximal inspiration
:RV
Volume remaining after maximal expiration
Total Lung Capacity:
Residual Volume
Spirometry Results
RAD- all low, except TLC normal and Vol N
Narrow curver
Obstrucive- wider curve
