Respiratory Disorders: Asthma Flashcards
What is asthma?
chronic inflm of a/w with reversible episodes of a/w obstruction
Asthma is closely related to _______
COPD
What 2 response occur from chronic inflm of the a/w?
- hyper-response
2. recurrent, reversible bronchospasm
How are a/w hyper-responsive?
structures are easily irritated
What are known triggers? What happens when encountered?
- something that is known to set off an episodic a/w obstruction
- pt will react with bronchospasm and inflm
During a recurrent, reversible bronchospasm, the a/w is ___________ to other known _______
hyper-responsive
triggers
Bronchospasm involves the spontaneous _______ of the______ _______ and remains in that state until __________ _________ subsides
contraction
smooth muscle
asthmatic episode
The lumen is compromised d/t ________ _________ = ________ muscles
muscle hypertrophy = enlarged muscles
What is the difference if atopic and non-atopic forms?
Atopic = allergic conditions/disorders that are genetically based due to a genetic component
Non-Atopic = conditions/disorders similar to allergies that not genetically based
Atopic form is also known as _________ from?
Extrinsic Form
T or F: Non-Atopic is Extrinsic form
FFFFFFF!!!!!!
IINTRINSIC
Give an example of extrinsic form (atopic)?
allergic rhinitis, asthma, and atopic dermatitis (eczema)
Atopic form is typically associated with heightened ______ ________ to common ______ esp _______ allergens and _____ allergies
IR
allergens
inhaled
food
Asthma is largely _____ b/c there is type 1 ________
atopic
hypersensitivity
Etiology of Asthma (3)
- complex trait
- hypersensitivity to stimuli
- T2H cell differentiation
What is the complex trait etiology?
genetic component and environmental factors
Hypersensitivity/Hyper-response is related to ________ component. Pt w/ asthma are hypersensitive to triggers such as _____, strong _____, _____, and a/w _______.
genetic
allergens, strong odours, exercise/exertion, and a/w irritants
How does exercise trigger an asthmatic episode with inhaling an allergen? How does it present (2)?
places an increase burden in the compromised respiratory system
SOB and respiratory distress
Explain how T2H cell differentiation cause Asthma?
During differentiation of T cells, more T2H are formed than T1H cells in asthma.
Function of T2H vs T1H cells?
T2H cells: responds to allergens and intestinal parasites by stimulating differentiation of B cells into IgE-producing plasma cells acting as growth factors for mast cells and activating more eosinophils
T1H cells: responds to microbes and stimulate the differentiation of B cells into IgG- and IgM producing plasma cells
In an infection, what is the function of macrophage and T cells?
engulfs foreign microbe and presents to T cells
T cells produce clones to target bacteria
In respiratory infection , there is a shift to more _____ cells
T1H
In patho: the trigger –> increase _______—> 2 phase response. What are the phase called?
hypersensitivity
early phase and late phase
Fig 29.6: What happens in the early phase?
Allergens trigger T helper cells –> IgE are produced –> IgE binds to mast cells –> mast cells get sensitized and release mediators–> causing BRONCHOSPASM (parasympathetic receptors)
In early phase, symptoms develop within ____-____ mins but can be inhibited/reversed by ______ such as __ _______ agonists
10-20
bronchodilators
Beta-2 adrenergic
What are the effects of chemical mediators in early phase (3)?
- increase mucus secr.
- increase mucosal intercellular junctions
- bronchoconstriction
What are the consequence of increased mucosal intercellular junction?
allows antigen (allergens) and sensitized mast cells to enter the submucosa into the muscle layers which are also impacted by bronchospasm
Fig 29.6: What happens in the late phase?
allergens move into submucosa causing influx of inflm cells –> release more inflm mediators –> exacerbates bronchospasm and bronchoconstriction
In late phase, what injuries occurs in submucosa layer (5)
- edema
- epithelial cell injury
- decreased mucociliary function
- accum. of mucus
- increased a/w responsiveness
An individual suffers an asthmatic episodes from cig smokes and move out of building and inhale cool air the episode does not subside. WHY?
In late phase, there is an increase a/w responsiveness therefore a/w is hyper-responsive to new triggers eg cool air
The late phase develops within ____-____ hours after exposure an asthmatic trigger.
4-8
What are the symptoms of early phase (7)?
- type 1 H
- allergen binds to IgE on mast cells –> mediators –> inflm
- intercellular junctions open –> allergen enter submucosa
- increase permeability and mucus hypersec–> edema of a/w
- bronchospasm
- dyspnea and wheezing
- bronchoconstriction
What is the duration of early response? How can relieve it?
less than 1 hour
a puffer
Why is there an increase in permeability? and How?
inflm –> increase prod of mucus–>inflm cell release mediators–> mediators results in hyperemia and vasodilation
Dyspnea and wheezing is present in severe ___________ ________
respiratory distress
How is bronchoconstriction a compensatory mechanism? Give example
inhaled allergen (eg noxious fumes) cause bronchoconstriction b/c it prevents inhalation of more allergens
In the late phase, what 2 things happen when there is an influx of inflm cells?
- decrease mucociliary blanket function
2. a/w become hyper-responsive
Late response is in ____% of all cases and may last for ____ or _____ as it is a ____-_________ cycle of _______________
50%
days or weeks
self-sustained
exacerbation
In late phase, a/w is responsive to ____ _______ and it is ________ and _____
responsive to new triggers
frequent and severe
Which receptors cause bronchodilation when activated? What type of drugs and example?
beta adrenergic receptors
beta adrenergic agonists eg anticholinergic and ipratropium
Which receptors cause Bronchoconstriction when activated? What type of drugs and example?
alpha adrenergic receptors
alpha adrenergic agonists eg. adrenaline (Epinephrine)
________ _____ or _____ regulates the a/w smooth muscles. It is a _____ in many __________ processes in the body
Cyclic AMP or cAMP
mediator
physiological
Theory suggests that asthma is d/t l/o _____ _______ ___________. There is a proposed problem with the ______ _________.
beta receptors stimulation
beta receptors
Manifestations of Asthma (5)
- dyspnea
- wheezing and coughin
- bronchospasm
- increase respiratory effort
- Abn ABG profile
What is the coughing type?
productive cough
What 3 signs of increase respiratory effort?
- nasal flaring: nostrils open wide in effort to breathe
- purse-lip breathing: tunnel made with lips to suck in and breathe out air
- use of accessory muscle
What does the abn ABG profile indicate (2)?
- hypoxemia
2. hypercapnia
Diagnostic of Asthma (4)
- hx and px
- labs
- PFT
- Inhalation challenge test
What is the inhalation challenge test?
To determine the allergen and trigger, the individual inhale potential allergens to confirm dx.
What is a mucus plug?
Resembles the cast of respiratory tree of larger bronchus to finer a/w. It is expectorated in asthmatic attack. It is gel like.
Treatment of Asthma (2)
- shift from episodic to long term management to prevent episode of asthma
- preventative:
- avoid allergens and trigger
- no smoking
How many steps are in the stage based approach of drugs?
4 Stages
What is stage 1 of stage based approach of drugs? route?
Step 1 = short acting bronchodilators –> inhaled PRN eg puffers and inhalers
What is stage 2 of stage based approach of drugs? Why?
Add inhaled steroids to decrease inflm (localized effect)
What is stage 3 of stage based approach of drugs?
add long acting bronchodilators
What is stage 4 of stage based approach of drugs? What 2 drugs are used ?
- Steroids PO short course: oral steroids for a week to deal with acute onset of inflm
AND
- add 3rd drug to short acting bronchodilators, long-acting bronchodilators, and PO steroids
Examples = leukotriene receptor antagonists and theophylline
T or F: Theophylline is a first line drug
F!!!!!!!
last line drug (not used earlier on in disease)
What is the function of theophylline? Blood levels are required to achieve _______ dose not _____.
acts by relaxing bronchial smooth a/w
therapeutic
toxic
What is leukotrienes? What do leukotriene receptor antagonists do?
- A compound in the body that mediates inflm and allergic response to get the process going.
- leukotriene receptor antagonist inhibit the binding of the compound and minimizes inflm and allergic response
