Respiratory Lecture: Lower respiratory tract condition – COPD and Asthma b

Question 1

Asthma

Answer 1

Asthma and allergies are closely linked

Question 2

Risk of developing Asthma

Answer 2

•Indoor and outdoor pollution (including moulds, gases, chemicals, particles and cigarette
smoke) can increase the risk of developing asthma.
•Athletes can develop asthma after very intensive training over several years, especially
while breathing air that is polluted, cold or dry

Question 3

Asthma types

Answer 3

Extrinsic

Intrinsic

Question 4

Extrinsic

Answer 4

identifiable external
cause. Commonly occurs as a result
of allergic response with
development of IgE antibodies to
specific antigens. Tends to start in
childhood.

Question 5

Intrinsic

Answer 5

no external cause can be
identified. Generally appears in
adults

Question 6

Asthma: Diagnosis

Answer 6

Accurate patient history
-recognition of characteristic pattern of
symptoms and signs and the absence of an
alternative explanation
- History of atopy and allergic conditions
(e.g. eczema)
•Patient assessment
•Spirometry to assess for the
presence of airflow obstruction
•Serial peak expiratory flow

Question 7

Management of Asthma
DRUG THERAPY (Most Common)

Answer 7

Short acting 2 agonist (SABA)
Salbutamol
Inhaled Corticosteroids (ICS)
Fluticasone, Budesonide
Leukotriene receptor antagonists
Montelukast (Singulair®)
Mast cell stabilizers (cromone)
Sodium cromoglycate, Nedocromil sodium
Long acting 2 agonist (LABA)
Salmeterol, eformoterol, indacaterol

Question 8

Nursing Management

Answer 8

Assessment of respiratory function and detailed history (if patient not in
acute distress)
Care priorities
Education/patient teaching
• Asthma action plan
• Drug therapy and correct use of inhalers
• Peak flow meter

Question 9

Living with Asthma

Answer 9

Impact on the individual varies with disease severity but it can impact physical, mental and
social aspects of life.
The greater the severity the higher the impact on the ADL’s

Question 10

Impact on ADL for those with chronic asthma

Answer 10

1. General health status – compromised energy levels due to difficulty breathing out and
   poor oxygen absorption…. Affecting strength, ability to talk. (interaction socially with
   peers potentially affected)
2. Diet/activity restrictions – certain foods can trigger acute episodes
3. Loss of certainty, predictability for day to day events – acute attack can be triggered by
   many things at any time… may affect ability to plan
4. Loss of independence and self care ability – maintenance of independence requires
   more motivation as disease progresses… mental health.

Question 11

Associated
Comorbiditie
s and risk
factors

Answer 11

Physical inactivity
smoking
weight
poeple with asthma 
has one more chronic condition, mental problems, like to report COPD, cardiovascular disease

Question 12

Out of
pocket
healthcare
expenditure
and chronic
disease

Answer 12

more likely to forgo healthcare because of cost

skip healthcare

Question 13

Respiratory
Failure
causes

Answer 13

airway obstruction
central drive
lung parenchyma
neuromuscular junction
peripheral nerves
other

Question 14

Mechanism of arterial hypoxia

Answer 14

Low inspired PO2
Hypoventilation
Diffusion impairment
Ventilation-perfusiion mismtatching
Right to left shunt

Question 15

Respiratory Failure

Answer 15

Type I Respiratory failure (Hypoxaemic respiratory failure)
Low arterial oxygen (PaO2 < 60mmHg) AND normal or low arterial carbon dioxide
(PaCO2 < 45mmHg)
Type II Respiratory failure (Hypercapnic respiratory failure)
Low arterial oxygen (PaO2 < 60mmHg) AND increased/high arterial carbon dioxide
(PaCO2 > 50 mmHg)

Question 16

Respiratory Failure

can be

Answer 16

Respiratory failure can be ACUTE or CHRONIC

Question 17

Pathophysiology of Type I

respiratory failure

Answer 17

Numerous causes but broadly speaking
it is failure of oxygenation
1. Low inspired PO2
2. Alveolar Hypoventilation
3. Diffusion impairment
4. V/Q mismatch
5. Shunt

Question 18

Pathophysiology of Type II

respiratory failure

Answer 18

Failure of the respiratory muscle
pump or ventilatory failure.
This has three components;
•Neural respiratory drive
•Respiratory muscle pump capacity
•Increase in respiratory load that
cannot be overcome

Question 19

Common Causes of Respiratory failure type 1

Answer 19

Asthma
• Pneumonia
• Shock
• Anatomical shunt (VSD)
• Pulmonary oedema
• Pulmonary embolism

Question 20

Common Causes of Respiratory failure type 2

Answer 20

Type II
• Asthma
• COPD
• CF
• Drug Overdose
• Cystic fibrosis
• Sleep apnoea
• Chronic neuromuscular disorders
• Chest wall disorders
• Morbid obesity

Question 21

Signs of hypoxaemia

Answer 21

• Peripheral
• Cyanosis
• Cerebral
• Headache, nausea, agitation, restless and combative behavior, disorientation,
drowsiness, convulsions, coma (severe/late)
• Respiratory
• Dyspnoea, tachypnoea, inability to speak in sentences, use of accessory
muscles,  SpO2
• Cardiovascular
• Tachycardia, hypertension, skin cool clammy and diaphoretic, dysrhythmias,
bradycardia and hypotension (severe/late sign)

Question 22

Signs of hypercapnia

Answer 22

• Cardiovascular
• Headache, bounding peripheral pulses, hypertension, tachycardia, flushing,
warm peripheries
• Other
• Signs of hypoxaemia

Question 23

Investigations/diagnostic studies

Answer 23

Physical assessment
ABG
Chest X-ray
Pathology
FBC
Serum electrolytes
Blood cultures/sputum cultures
PFT (chronic respiratory failure)
Other diagnostic tests are aimed at diagnosing and/or treating underlying cause

Question 24

Management

Answer 24

Preserve oxygenation and ventilation
Direct treatment towards underlying cause
Respiratory support
• Oxygen therapy
• NIV (CPAP/BiPAP)
• Invasive ventilation
Mobilisation of secretions
• Hydration and humidification
• Chest physiotherapy
• Nasopharyngeal, oropharyngeal suctioning