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732 > Session 12_Asthma > Flashcards

Session 12_Asthma Flashcards

1
Q

What is impacted in obstructive pulmonary disease?

A

flow

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2
Q

In obstructive pulmonary disease air gets _____________________________.

A

Trapped in the lungs

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3
Q

Examples of obstructive diseases are:

A
  • emphysema
  • asthma
  • chronic bronchitis
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4
Q

Examples of septic obstructive pulmonary diseases are:

A
  • cystic fibrosis

* bronchiectasis

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5
Q

From which type of obstructive disease are you more likely to get an infection?

A

septic

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6
Q

Emphysema is caused by a destruction of the air spores. Describe the differences in how the alveoli appear:

A

normal alveoli are pink, and nicely rounded.

In emphysema the air spaces areas are stretched out and appear darker in appearance.

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7
Q

What is impacted in restrictive pulmonary disease?

A

volume

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8
Q

In restrictive pulmonary disease its hard to get air ____________ and in obstructive pulmonary disease it is hard to get air _________.

A

IN

OUT

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9
Q

Restrictive pulmonary disease is:

A
  • linked to immune disorders, occupational exposures, genetic and hormonal abnormalities and a complication of lung injury
  • loss of lung compliance and chest wall expansion
  • decreased depth and increased rate of breathing
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10
Q

In restrictive pulmonary disease, the lung tissue is less _____________ and becomes ___________________

A

less elastic

tighter and tougher

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11
Q

know slide 6

A

know slide 6

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12
Q

normal FEV1 =

A

80%-120%

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13
Q

with restrictive FEV1/FCV ratio =

A

> 80%

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14
Q

Normal FEV1/FVC ratio =

A

70-80%, ~75%

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15
Q

in obstructive disease, the ratio of FEV1/FCV :

A

decreases

FVC is stable and FEV1 is smaller

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16
Q

Asthma is an example of what type of pulmonary disease?

A

obstructive

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17
Q

Asthma is a chronic disease characterized by _____________ obstruction to airflow within the lungs.

A

reversible

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18
Q

list some risk factors of asthma:

A
  • childhood asthma
  • family history
  • atopy (hypersensitive skin response to common irritants)
  • maternal smoking
  • occupational exposure
  • environmental exposure
  • secondary smoke
  • gender - (female 2-fold increase)
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19
Q

rhinitis =

A

inflammation of the nose / sinuses

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20
Q

Of children with asthma 77% have _________________, 17% have _____________ and 91% have __________________.

A

77% have had allergic rhinits,
17% had eczema and
91% have a family history of allergy in 1st degree relative.

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21
Q

1 parent having asthma –>

2 parents having asthma –>

A

1:3 chance

7/10

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22
Q

In America, 1 out of __ Americans have asthma.

A

5

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23
Q

What is the most common childhood disease?

A

asthma

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24
Q

how many deaths/year are associated with asthma?

A

> 4000

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25
Q

Ethnic difference in asthma prevalence, morbidity and mortality are highly correlated with:

A
  • poverty
  • urban air quality
  • indoor allergens
  • lack of patient education and inadequate medical care
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26
Q

_____ of all emergency room visits in 1 year = ___________.

A

1/4

= 2 million

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27
Q

wheezing is described as:

A

high pitched whistling sounds when breathing out

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28
Q

List some signs and symptoms of asthma:

A
  • cough, worse particularly at night
  • recurrent wheeze
  • recurrent difficulty in breathing
  • recurrent chest tightness

theses symptoms lead to fatigue

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29
Q

Symptoms of asthma worsen in

A
  • exercise
  • viral infection
  • animals with fur or hair
  • house-dust mites (in mattresses, pillows, upholstered furniture, carpets)
  • mold
  • smoke (tobacco, wood)
  • pollen
  • changes in weather
  • strong emotional expression (laughing or crying hard)
  • airborne chemicals or dusts
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30
Q

Symptoms often worsen at ___________, awakening the patient. Lung function is relatively __________ between episodes.

A

night

normal

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31
Q

What are 3 components of asthma?

A
  1. bronchoconstriction
  2. swelling
  3. mucus plug
    (narrowing due to mucus plug)
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32
Q

during an asthmatic attack the muscles around the airways __________________________, airways ___________________ and fill with _______________.

A

muscles around the airways SQUEEZE AND CONSTRICT AIRFLOW
airways SWELL
airways fill with MUCUS

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33
Q

chronic asthma will have:

A

chronic changes

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34
Q

Intermediate type hypersensitivity reaction results in:

A
  • direct stimulation of airway muscles

* indirect stimulation by mediator-secreting cells

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35
Q

pathophysiology of an asthma attack includes mast cell releasing:

A

histamines

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36
Q

pathophysiology of an asthma include cells of immune system stimulating ________.

A

airways.

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37
Q

pathophysiology of asthma -acute -

A
  • inflammation: increased capillary permeability

* smooth muscle contraction

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38
Q

pathophysiology of asthma -chronic-

A
  • mucus production
  • inhibition of mucociliary clearance
  • airway changes
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39
Q

What do bronchial sensitivity triggers cause?

A
  1. airway inflammation
  2. intermittent airflow obstruction
  3. bronchial hyperresponsiveness
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40
Q

List some common bronchial sensitivity triggers:

A
  • Allergens (pollen, animal dander, dust mites, cockroaches)
  • Irritants [irritating substances (smoke, pollution, odors) sulfites (dried fruit, wine)]
  • Other (weather/ environmental, exercise, low SES, fewer resources, more “dirt” roads)
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41
Q

What are the results of inflammation?

A

increased resistance to airflow –> increased work of breathing –> decreased ventilation

42
Q

FEV1 / FVC % =

A

% of air exhaled from lungs in 1 second relative to total amount exhaled

43
Q

FEF 25-75 =

A

average rate of flow at mid-exhalation (>65% okay, 0 = no flow, 100 = full flow)

44
Q

Flow volume loop =

A

forced expiration& completing cycle of inspiration / inhalation (80-120% of average of population)

45
Q

FEV1 =

A

amount of air out in first second

46
Q

how much air goes out in first second?

A

70-80%

47
Q

ratio of FEV1/FVC =

A

70%-80%

48
Q

80-120% what is this ________ average of population??

A

80-120% what is this ________ average of population??

49
Q

FEF =

A

forced expiratory flow

average rate of flow at mid-exhalation

25-75

0 = no flow 
100 = full flow
50
Q

what is considered okay for FEF?

A

> 65%

51
Q

if FEV1/FVC is less than 70-80% and the FEV1 increases more than 12% with bronchodilator =

A

asthma

52
Q

How do you diagnosis Asthma?

A
  1. airway obstruction is episodic AND reversible
  2. spirometry to establish airway obstruction
  3. post-bronchodilator response - primary test to diagnosis asthma
  4. In airway obstruction: FEV1 80, >65 for normal)
  5. Reversibility: FEV1 increases > 12% with ≥200ml change after short acting beta2-agonist
53
Q

What are 2 other diagnositc tests for asthma?

A
  1. exercise challenge
  2. methacholine challenge (>20% decrease in FEV1, will have bronchial construction. Then will have bronchodilator)
    - (Bronchodilator will cause greater response in individuals w/ asthma)
54
Q

Severity of asthma is based on :

A 
• # of days w/ symptoms
• night with symptoms
• PEF or FEV1
• PEF variability 
(higher variability --> worse asthma)
* classified based on the most severe feature
55
Q

Peak expiratory flow meter =

A

???

56
Q

Medications for all levels of severity of asthma =

A

in addition to regular daily controller therapy, rapid-acting inhaled beta2-agonist should be taken as needed to relieve symptoms, but it should not be taken more than 3-4 times per day. Patient education is essential at every level

57
Q

List the common medications used to treat asthma:

A
  1. Albuterol
  2. atrovent
  3. salmeteral (serovent)
  4. Inhaled steroids (advair, floven, symbicort)
58
Q

What is the onset and duration of Albuterol?

A

O: 5-15 min
D: 3-6 hrs

59
Q

What is the onset and duration of atrovent?

A

O: 15 min
D: 3-4 hours

60
Q

What is the onset and duration of salmeteral (serovent)?

A

O: 10-20 min
D: 12 hours

61
Q

Describe the pharmacotherpay for asthma:

A
  • stepwise control
  • Persistent asthma needs 2 step process:
  1. long term control (steroids, leukotriene antagonists, long acting beta agonist)
  2. acute exacerbations (albuterol or short acting beta agonist)
62
Q

What 4 components of asthma do the guidelines for care focus on?

A
  1. measures to assess and monitor asthma
  2. patient education
  3. control of environmental factors and other conditions that can worsen asthma
  4. and medications
63
Q

How often should patients with asthma be seen?

A

1-6 months

64
Q

What are 4 comorbidities associated with asthma?

A
  1. obesity
  2. sinusitis
  3. GERD
  4. sleep apnea
65
Q

List consequences of asthma:

A
  • hyperexpansion of thorax
  • postural changes
  • decreased physical fitness
  • school absence
  • restricted physical activity
  • change in family/social systems
  • increased hospitalizations
66
Q

Explain the effectiveness on breathing exercise training on asthma:

A
  • FEV1 - non significant
  • FVC - non significant
  • Peak expiratory flow rate (PEFR) - significant improvement in mean daily PEFR (60L/min)
  • Rescue beta agonsit - decreased by 6 does/week
  • 49% reduction from using corticosteroids
  • QOL(quality of life) improved
67
Q

Exercise induced asthma (EIA) what is the primary problem?

A

dry/ cool air getting into the airway

68
Q

With asthma get airway:

A

airway drying and cooling

69
Q

Airway drying causes:

A

•hyperemia –> increased permeability –> swelling

70
Q

airway cooling causes:

A

• hyperemia –> to reheat the airway –> swelilng

71
Q

hyperemia =

A

an excess of blood in the vessels supplying an organ or other part of the body.

72
Q

what is the general incidence of EIA

A

3-10%

73
Q

A 35-50% incidence increase of EIC is caused by what and seen in whom?

A

cold weather athletes, figure skater, ice hockey, nordic skiing

74
Q

What factors are MOST likely causing EIA?

A
  1. continuous hard exercise (running)
  2. Exercise in cold EN
  3. Ex in polluted air
  4. Ex in pollen season for allergic athletes
  5. EX during upper respiratory infection
75
Q

What factors are LEAST likely to cause EIA?

A
  1. intermittent exercise
  2. swimming
  3. exercise in warm, humid air
  4. exercise in non-polluted air
76
Q

What are the PT treatment implications for Asthma?

A
  1. pre-treat with B-agonist before exercise (some allowed in competition)
  2. measure peak flow before and after exercise
  3. listen for wheezing before and after EX
  4. early and longer warm-up period
  5. increase humidity in EX area
  6. have pt breathe through nose
  7. short exertion periods (intermittent ex) may decrease need for medications
77
Q

What are the effects of physical training on Asthma?

A

• training minimum 20 minutes aerobic exercise 2x/week minimum of 4 weeks
==> Effects: no effect on resting PEFR, FEV1, FVC / VO2 max increased ~ 5ml/kg/min / HR max increased / health-related quality of life improved
CONCLUSION: “PHYSICAL TRAINING WAS WELL TOLERATED AMONG PEOPLE WITH ASTHMA IN THE INCLUDED STUDIES”

78
Q

Describe Cystic Fibrosis (CF):

A
  • congenital disease of exocrine glands
  • symptomatic individuals must inherit a defective gene from each parent
  • “The infant that tastes of salt will surely die” (European folklore)
79
Q

Cystic fibrosis transmembrane conductance regulator (CFTR) gene normally opens:

A

channel through plasma membrane of cell to allow chloride to pass through

80
Q

What happens to the CFTR gene?

A

defective gene = faulty salt movement of Na+ and CI-

81
Q

What is the primary symptoms of CF?

A

dry, sticky mucous lining airways of lungs

82
Q

Why is sweat initially tested in CF?

A

in CF, when the CFTR gene is defective, the sweat glands produce saltier secretions.

83
Q

Normally, the positively charged NA ions follow the CI, and the NACI combination does what?

A

pulls out water to line the airway with fluid.

84
Q

But in CF, the defective CFTR protein does what specifically differently?

A

blocks the CI channels, so TOO MUCH NA and water are pulled into the cell, leaving behind dry mucous

85
Q

What are the consequences of a defective CFTR?

A

In both healthy and CF-affected lungs, the airway cells have tiny, hairlike projections called cilia. In healthy lungs, the fluid lining the airway traps potentially harmful substances, and the cilia beat in a coordinated action to sweep the foreign substances out. But in CF lungs, the airway fluid is mostly a mucus so thick and sticky that the cilia can hardly move. Bacteria stay trapped and can eventually cause infections.

86
Q

What organ has less water in CF?

A

intestines

87
Q

Pancreative enzymes help break down protein, fats and carbs. In CF what occurs differently?

A
  1. epithelial dysfunction
  2. pancreatic enzymes do not cross the cell membrane
  3. get mucus blocks (pancreative cells DON’T CROSS THE MEMBRANE)

(individuals w/ CF are usually very thin)

88
Q

Name 3 consequences of CF:

A
  1. severe lung infections
  2. decreased release of pancreatic enzymes (poor nutrition)
  3. reproductive blockage
89
Q

List some additional consequences of CF:

A
  1. oxygen deprivation
  2. clubbed fingers
  3. signs of hypoxemia - poor gas exchange
  4. additional progressive chagnes
90
Q

What are 2 common pulmonary infections? How are they transmitted and where do they colonize?

A
  1. staphylococcus aureus - early
  2. pseudomonas aeruginosa - primary
    • Transmitted by respiratory or hand contact
    • Usually colonize in lungs and difficult to eradicate
91
Q

Describe the cycle of infection associated with CF:

A

MUCUS PLUGS –> (microorganisims are trapped in the lungs) –> INFECTION –> (the body’s defenses against infection are activated) MORE MUCUS PRODUCED –> (swollen airways and more mucus lead to obstruction)

92
Q

BRONCHIECTASIS results from CF, Describe bronchiectasis:

A

(1) mucus production increases, (2) the cilia are destroyed or damage, and (3) areas of the bronchial wall become chronically inflamed and are destroyed.

93
Q

What are 4 treatments of pulmonary infections?

A
  1. inhaled bronchodilator
  2. mucolytics
  3. airway clearance (AD or ACB / ThAirapy Vest)
  4. antibiotics
94
Q

Describe pulmonary medications related to CF and pulmonary infections:

A

• beta agonist bronchodialtors
• Pulmozyme
–> inhaled medication that thins mucus
–> acts by breaking down DNA ni sputum and thinning secretions
• Guaifenesin
–> oral medication that thins mucus
ANTIBIOTICS
• Aminoglycosides - Gentamicin Tobramycin
–> act by preventing bacteria from reproducing
* Inhaled Tobramycin TOBI
• Azithromycin
–> Improve lung function and prevent hospitalization if P aeruginosa

95
Q

Ivacaftor is a new pharmacology therapy for CF; explain it:

A

CFTR potentiator which enhances CFTR function. It enhances lung function. Sweat CI levels approach normal.

96
Q

What is the current lifespan of an individual born with CF?

A

~ 50 years

97
Q

What are 3 rheumatoid disease in patients with CF?

A
  1. cystic fibrosis arthropathy
  2. hypertrophic arthropathy
  3. osteoporosis
98
Q

Describe CF arthopathy:

A

• prevalence 8-10% of CF
• recurrent, painful mono or polyarthritis
• erythema nodosum rash
• negative for rheumatoid antibodies, however:
–> circulating immune complexes
• Normal radiograph or joint effusion
• occurs with late pulmonary or pancreatic manifestations
• may respond to NSAIDS

99
Q

Describe hypertrophic pulmonary osteoarthropathy:

A

• occurs in 2-7% of CF adults (high prevelance)
(* due to lack of nutrition from) atypical pancreas function
• linked with disease severity
• Symptoms include: finger clubbing, chronic inflammation (periostitis) of long bones, joint inflammation wrist, knee, ankle
• Possible abnormal platelet function
• Treated with NSAIDS

100
Q

Summary (CF):
(people with CF who exercise have a reduction in change in lung function / –> better lung function with exercise vs nothing)

A

exercise –> breathing training –> monitor –> airway clearance –> educate

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