Session 12_Asthma Flashcards
What is impacted in obstructive pulmonary disease?
flow
In obstructive pulmonary disease air gets _____________________________.
Trapped in the lungs
Examples of obstructive diseases are:
- emphysema
- asthma
- chronic bronchitis
Examples of septic obstructive pulmonary diseases are:
- cystic fibrosis
* bronchiectasis
From which type of obstructive disease are you more likely to get an infection?
septic
Emphysema is caused by a destruction of the air spores. Describe the differences in how the alveoli appear:
normal alveoli are pink, and nicely rounded.
In emphysema the air spaces areas are stretched out and appear darker in appearance.
What is impacted in restrictive pulmonary disease?
volume
In restrictive pulmonary disease its hard to get air ____________ and in obstructive pulmonary disease it is hard to get air _________.
IN
OUT
Restrictive pulmonary disease is:
- 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
In restrictive pulmonary disease, the lung tissue is less _____________ and becomes ___________________
less elastic
tighter and tougher
know slide 6
know slide 6
normal FEV1 =
80%-120%
with restrictive FEV1/FCV ratio =
> 80%
Normal FEV1/FVC ratio =
70-80%, ~75%
in obstructive disease, the ratio of FEV1/FCV :
decreases
FVC is stable and FEV1 is smaller
Asthma is an example of what type of pulmonary disease?
obstructive
Asthma is a chronic disease characterized by _____________ obstruction to airflow within the lungs.
reversible
list some risk factors of asthma:
- childhood asthma
- family history
- atopy (hypersensitive skin response to common irritants)
- maternal smoking
- occupational exposure
- environmental exposure
- secondary smoke
- gender - (female 2-fold increase)
rhinitis =
inflammation of the nose / sinuses
Of children with asthma 77% have _________________, 17% have _____________ and 91% have __________________.
77% have had allergic rhinits,
17% had eczema and
91% have a family history of allergy in 1st degree relative.
1 parent having asthma –>
2 parents having asthma –>
1:3 chance
7/10
In America, 1 out of __ Americans have asthma.
5
What is the most common childhood disease?
asthma
how many deaths/year are associated with asthma?
> 4000
Ethnic difference in asthma prevalence, morbidity and mortality are highly correlated with:
- poverty
- urban air quality
- indoor allergens
- lack of patient education and inadequate medical care
_____ of all emergency room visits in 1 year = ___________.
1/4
= 2 million
wheezing is described as:
high pitched whistling sounds when breathing out
List some signs and symptoms of asthma:
- cough, worse particularly at night
- recurrent wheeze
- recurrent difficulty in breathing
- recurrent chest tightness
theses symptoms lead to fatigue
Symptoms of asthma worsen in
- 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
Symptoms often worsen at ___________, awakening the patient. Lung function is relatively __________ between episodes.
night
normal
What are 3 components of asthma?
- bronchoconstriction
- swelling
- mucus plug
(narrowing due to mucus plug)
during an asthmatic attack the muscles around the airways __________________________, airways ___________________ and fill with _______________.
muscles around the airways SQUEEZE AND CONSTRICT AIRFLOW
airways SWELL
airways fill with MUCUS
chronic asthma will have:
chronic changes
Intermediate type hypersensitivity reaction results in:
- direct stimulation of airway muscles
* indirect stimulation by mediator-secreting cells
pathophysiology of an asthma attack includes mast cell releasing:
histamines
pathophysiology of an asthma include cells of immune system stimulating ________.
airways.
pathophysiology of asthma -acute -
- inflammation: increased capillary permeability
* smooth muscle contraction
pathophysiology of asthma -chronic-
- mucus production
- inhibition of mucociliary clearance
- airway changes
What do bronchial sensitivity triggers cause?
- airway inflammation
- intermittent airflow obstruction
- bronchial hyperresponsiveness
List some common bronchial sensitivity triggers:
- 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)
What are the results of inflammation?
increased resistance to airflow –> increased work of breathing –> decreased ventilation
FEV1 / FVC % =
% of air exhaled from lungs in 1 second relative to total amount exhaled
FEF 25-75 =
average rate of flow at mid-exhalation (>65% okay, 0 = no flow, 100 = full flow)
Flow volume loop =
forced expiration& completing cycle of inspiration / inhalation (80-120% of average of population)
FEV1 =
amount of air out in first second
how much air goes out in first second?
70-80%
ratio of FEV1/FVC =
70%-80%
80-120% what is this ________ average of population??
80-120% what is this ________ average of population??
FEF =
forced expiratory flow
average rate of flow at mid-exhalation
25-75
0 = no flow 100 = full flow
what is considered okay for FEF?
> 65%
if FEV1/FVC is less than 70-80% and the FEV1 increases more than 12% with bronchodilator =
asthma
How do you diagnosis Asthma?
- airway obstruction is episodic AND reversible
- spirometry to establish airway obstruction
- post-bronchodilator response - primary test to diagnosis asthma
- In airway obstruction: FEV1 80, >65 for normal)
- Reversibility: FEV1 increases > 12% with ≥200ml change after short acting beta2-agonist
What are 2 other diagnositc tests for asthma?
- exercise challenge
- methacholine challenge (>20% decrease in FEV1, will have bronchial construction. Then will have bronchodilator)
- (Bronchodilator will cause greater response in individuals w/ asthma)
Severity of asthma is based on :
• # of days w/ symptoms • night with symptoms • PEF or FEV1 • PEF variability (higher variability --> worse asthma) * classified based on the most severe feature
Peak expiratory flow meter =
???
Medications for all levels of severity of asthma =
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
List the common medications used to treat asthma:
- Albuterol
- atrovent
- salmeteral (serovent)
- Inhaled steroids (advair, floven, symbicort)
What is the onset and duration of Albuterol?
O: 5-15 min
D: 3-6 hrs
What is the onset and duration of atrovent?
O: 15 min
D: 3-4 hours
What is the onset and duration of salmeteral (serovent)?
O: 10-20 min
D: 12 hours
Describe the pharmacotherpay for asthma:
- stepwise control
- Persistent asthma needs 2 step process:
- long term control (steroids, leukotriene antagonists, long acting beta agonist)
- acute exacerbations (albuterol or short acting beta agonist)
What 4 components of asthma do the guidelines for care focus on?
- measures to assess and monitor asthma
- patient education
- control of environmental factors and other conditions that can worsen asthma
- and medications
How often should patients with asthma be seen?
1-6 months
What are 4 comorbidities associated with asthma?
- obesity
- sinusitis
- GERD
- sleep apnea
List consequences of asthma:
- hyperexpansion of thorax
- postural changes
- decreased physical fitness
- school absence
- restricted physical activity
- change in family/social systems
- increased hospitalizations
Explain the effectiveness on breathing exercise training on asthma:
- 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
Exercise induced asthma (EIA) what is the primary problem?
dry/ cool air getting into the airway
With asthma get airway:
airway drying and cooling
Airway drying causes:
•hyperemia –> increased permeability –> swelling
airway cooling causes:
• hyperemia –> to reheat the airway –> swelilng
hyperemia =
an excess of blood in the vessels supplying an organ or other part of the body.
what is the general incidence of EIA
3-10%
A 35-50% incidence increase of EIC is caused by what and seen in whom?
cold weather athletes, figure skater, ice hockey, nordic skiing
What factors are MOST likely causing EIA?
- continuous hard exercise (running)
- Exercise in cold EN
- Ex in polluted air
- Ex in pollen season for allergic athletes
- EX during upper respiratory infection
What factors are LEAST likely to cause EIA?
- intermittent exercise
- swimming
- exercise in warm, humid air
- exercise in non-polluted air
What are the PT treatment implications for Asthma?
- pre-treat with B-agonist before exercise (some allowed in competition)
- measure peak flow before and after exercise
- listen for wheezing before and after EX
- early and longer warm-up period
- increase humidity in EX area
- have pt breathe through nose
- short exertion periods (intermittent ex) may decrease need for medications
What are the effects of physical training on Asthma?
• 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”
Describe Cystic Fibrosis (CF):
- 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)
Cystic fibrosis transmembrane conductance regulator (CFTR) gene normally opens:
channel through plasma membrane of cell to allow chloride to pass through
What happens to the CFTR gene?
defective gene = faulty salt movement of Na+ and CI-
What is the primary symptoms of CF?
dry, sticky mucous lining airways of lungs
Why is sweat initially tested in CF?
in CF, when the CFTR gene is defective, the sweat glands produce saltier secretions.
Normally, the positively charged NA ions follow the CI, and the NACI combination does what?
pulls out water to line the airway with fluid.
But in CF, the defective CFTR protein does what specifically differently?
blocks the CI channels, so TOO MUCH NA and water are pulled into the cell, leaving behind dry mucous
What are the consequences of a defective CFTR?
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.
What organ has less water in CF?
intestines
Pancreative enzymes help break down protein, fats and carbs. In CF what occurs differently?
- epithelial dysfunction
- pancreatic enzymes do not cross the cell membrane
- get mucus blocks (pancreative cells DON’T CROSS THE MEMBRANE)
(individuals w/ CF are usually very thin)
Name 3 consequences of CF:
- severe lung infections
- decreased release of pancreatic enzymes (poor nutrition)
- reproductive blockage
List some additional consequences of CF:
- oxygen deprivation
- clubbed fingers
- signs of hypoxemia - poor gas exchange
- additional progressive chagnes
What are 2 common pulmonary infections? How are they transmitted and where do they colonize?
- staphylococcus aureus - early
- pseudomonas aeruginosa - primary
• Transmitted by respiratory or hand contact
• Usually colonize in lungs and difficult to eradicate
Describe the cycle of infection associated with CF:
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)
BRONCHIECTASIS results from CF, Describe bronchiectasis:
(1) mucus production increases, (2) the cilia are destroyed or damage, and (3) areas of the bronchial wall become chronically inflamed and are destroyed.
What are 4 treatments of pulmonary infections?
- inhaled bronchodilator
- mucolytics
- airway clearance (AD or ACB / ThAirapy Vest)
- antibiotics
Describe pulmonary medications related to CF and pulmonary infections:
• 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
Ivacaftor is a new pharmacology therapy for CF; explain it:
CFTR potentiator which enhances CFTR function. It enhances lung function. Sweat CI levels approach normal.
What is the current lifespan of an individual born with CF?
~ 50 years
What are 3 rheumatoid disease in patients with CF?
- cystic fibrosis arthropathy
- hypertrophic arthropathy
- osteoporosis
Describe CF arthopathy:
• 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
Describe hypertrophic pulmonary osteoarthropathy:
• 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
Summary (CF):
(people with CF who exercise have a reduction in change in lung function / –> better lung function with exercise vs nothing)
exercise –> breathing training –> monitor –> airway clearance –> educate
