Ch 12 Asthma
Cardiopulmonary Disease chapter 12 Des Jardins
Terms in this set (123)
A disease characterized by an increase responsiveness of the
trachea and bronchi to various stimuli, manifested by recurrent attacks of widespread narrowing of the airway.
Define the term status asthmaticus
a severe asthmatic episode that does not respond to conventional pharmacologic therapy.
In Asthma identify the altered structures
Smooth muscle around airway, airway mucosa, goblet cells and bronchial mucous glands, airway cilia and basement membrance.
In Asthma what are the anatomic alterations of the lungs
Smooth muscle constriction of bronchial
Excessive production of thick, whitish,
tenacious bronchial secretions
Hyperinflation of alveoli (air-trapping)
Mucus plugging and, in severe cases,
List 5 precipitating or stimulator factors for the likelihood of asthma or may even increase susceptibility of asthma
smoking, viral infections, sm. size at birth, environmental pollutants
Describe the Radiographic study in Asthma
increased anteriorposterior diameter (barrel chest), translucent (dark) lung fields, depressed flattened diaphragms.
Describe what is a significant response to inhaled sympathomimetics, demonstrated by
what PFT parameter?
Stimulate sympathetic nervous system (ex. epinephrane)
significant response-increased heart rate (leads to bronchodilation)
PFT parameter- Tidal Volume
Describe how an ABG would differ from an acute asthma attack and status
Acute: PH increased , PaCO2 decreased, HCO3 decreased slightly, PaO2 decreased
Status Asthmaticus: PH decreased, PaCO2 increased, HCO3 increased slightly, PaO2 decreased
Describe the IgE or Type I immunologic reaction in common allergic disease.
List 5 antigens that may be responsible for Type I immunologic reactions.
pollen, mites, fungi, mold, yeast
Describe the role of Peak flow Meters, and the significance of the Green, Yellow, and
PEF measurements are used t odiagnose and monitor asthma.
Green Zone: asthma is under control if you symptoms begin to worsen and/or peak flow readings drop then you drop into
Yellow Zone: if yo ucontinue to get worse and quick relief meds dont work you drop into
Red Zone: you need to seek medical attention
Describe Pulse Paradoxus.
Pulses paradoxus is defined as systolic blood pressure that is more than 10mmHg lower on inspiration than expiration.
An exaggeratioin of the normal variation in the pulse volume with inspiration. Pulse becomes weaker with inspiration and stronger with expiration. Xteristic of constrictive pericarditis and pericardial effusion
Describe the clinical manifestations seen in asthma
Coughing, wheezing, shortness of breath, chest tightness
Describe what Wheezing is most often associated with?
Describe the sound heard when performing diagnostic percussion of the chest in
Asthma and the clinical manafestations that are associated.
Hyperresonant percussion note air in the lung (barrel chest)
What is a common non-pulmonary side effects is associated with the use of inhaled
oropharyngeal candidiasis, dysphonia, yeast/thrush infection
An asthma patient's best effort produces a PEFR of 82% of personal best. What is indicated at this time?
Patient should continue to take his or her controller medications.
Summarize the signs and symptoms of asthma. Include clinical tests.
episodic wheezing,chest tightness, sob, cough,
State the auscultary sounds with asthma
wheezing, diminished breath & heart sounds,
Summarize pulmonary function test results with an asthmatic patient.
decreased FVC,FEVt,FEV1/FVC ratio,VC,PEFR,
decreased expiatory flows and normal or increase volume unless severe conditions
How does Emergency drug treatment differ from chronic or maintenance drug
treatment, in the management of Asthma.
emergency would use your relief short term meds (i.e Albuterol is a rescue)
Describe the difference in the management of the patient with Emphysema with
the ABGs, pH 7.36 PaCO2 65 PaO2 55 and a patient with asthma with ABGs,
pH 7.32 PaCO2 52 PaO2 55.
Which of the following side effects is associated with the use of inhaled corticosteroids?
oropharyngeal candidiasis, dysphonia,
As a respiratory therapist, you are performing a chest assessment. What findings would be common in a patient during an asthma attack?
decrease vocal and tactile fremitus
hyperresonant percussion note
diminished breath sounds
diminished heart sounds
wheezing and rhonchi
Which of the following are associated with so-called extrinsic asthma?
allergic or atopic asthma
induced by outside allergens(spores,molds,pollens)
is mediated by IgE and their interaction with mast cells
chemicals cause the inflammatory response
Which of the following are associated with so-called intrinsic asthma?
If an asthmatic patient is given a sympathomimetic and parasympatholytic medication, what can be expected to happen?
Bronchial smooth muscle relaxation will occur through stimulating the beta2
A patient is having a severe asthma attack. What blood gas results would indicate to the respiratory therapist and physician that the patient is having great difficulty?
everything is decreased and HCO3 is significantly reduced
After a patient inhales a bronchodilator medication, what percentage change in FEV1 indicates a diagnosis of asthma?
FEV1 of > 12% or > 200ml
What stimulus is most commonly used in bronchoprovocation testing in the patient suspected to have asthma?
measurements of airway responsiveness to methacholine, histamine, mannitol, or exercise in order to diagnose.
A patient has been admitted to the hospital with a suspected asthma attack. What radiographic findings would confirm this diagnosis?
Increased anteroposterior diameter (barrel chest)
Translucent (dark) lung fields
Depressed or flattened diaphragms
A patient with a severe asthma attack has many mucus plugs. What structural changes can be expected because of this?
f an asthmatic patient is not properly treated and has long-term airway inflammation, what can occur?
Irreversible loss of airway caliber
Which of the following symptoms are classic symptom of asthma?
shortness of breath
What finding of the arterial blood gas suggests a more severe attack of asthma and impending respiratory failure?
Acute Respiratory Acidosis w/hypoxemia:
PH decreased, PaCO2 increased, HCO3 increased slightly, PaO2 decreased
A sputum sample from a suspected asthmatic patient has been sent to the laboratory for analysis. Which of the following findings would confirm the diagnosis?
What classification of drug would the leukotriene inhibitors fall under?
What test is most useful for the diagnosis of asthma in the symptom-free patient?
bronchoprovocation challenge testing
What controller medication is currently the most effective for the treatment of asthma?
Ex:Budesonide, ciclesonide, flunisolide
chronic dilation & distortion of one or more bronchi as a result of extensive inflammation & destruction of the bronchial wall cartilage, blood vessels, elastic tissue, & smooth muscle component.
Bronchiectasis can be congenital or?
Acquired= bronchial obstruction, foreign body aspiration
List the major pathologic or structural changes found in Bronchiectasis.
Chronic dilation and distortion of the bronchi, Excessive production of foul-smelling sputum, Smooth muscle constriction of bronchi, Hyperinflated alveoli, Atelectasis consolidation and fibrosis
What are the most common symptoms of Bronchiectasis?
~Sudden violent coughing spasm that often comes without warning, with changes in body position, or form sudden movements such as laughter.
~Cough brings up great amounts of mucus, frequently foul-smelling.
~colds also easily develop into pneumonia.
List four causes of Bronchiectasis
Congenital bronchiectasis: systemic disorder, kartageners syndrome.
Aquired bronchiectasis: Recurrent Pulmonary infection, bronchial obstruction
The preferred radiographic method to evaluate a patient's bronchiectasis is:
CT (computed tomography)
Severe bronchiectasis is associated with all of the following EXCEPT
vesicular breath sounds
Which of the following is the most accurate definition of bronchiectasis.
saclike or tubular dilation of the bronchi associated with the inflammation and destruction of the airway walls
Mechanical ventilation would be justified in the management of a patient with bronchiectasis under
patient has a reversible lung problem
Which of the following pulmonary function testing values would be found in a patient with severe, obstructive bronchiectasis?
Patients with bronchiectasis can have the following anatomic alterations:
Management of the patient with bronchiectasis may include:
expectorants, childhood immunizations, lung resection
Congenital causes of bronchiectasis include:
CF, kartagener's syndrome
For a patient with bronchiectasis to reduce the risk of his/her condition worsening, which of the following should be done?
avoid air polltuions, antibiotics, avoid smoking, get flu shot
A patient with long-standing bronchiectasis also has pneumonia. Which of the following hematology test results would be expected
increased hemoglobin & hematocrit, elevated WBC
Identify in most cases what is believed to be the cause of destruction of the bronchial walls of Bronchiectasis?
Extensive inflammation and destruction of the bronchial wall cartilage.
The smaller bronchi, with less supporting cartilage, are predominantly affected.
Describe mucopurulent sputum?
Mucopurulent sputum is a yellow-greenish color sample that suggests treatment with antibiotics might reduce symptoms. Green color is caused by Neutrophi Myelperoxidase, is thicker and often stickier than normal sputum. This is due partly to the greater production of mucus that is coupled with pus in the purulent types, a sign of respiratory tract infection, predominantly of the lungs and bronchi - pneumonia or acute bronchitis
Describe the combo extra pulmonary manifestations of long-standing bronchiectasis?
Define the term bronchography?
the injection of an opaque contrast material into the tracheobronchial tree
What is the most common tool used in the diagnosis of bronchiectasis?
Describe how Bronchiectasis may be an obstructive disorder as well as a restrictive component?
OBS: if majority of bronchial airways are only partially obstructed RES: if majority of bronchial airways are completely obstructed, distal alveoli collapse, atelectasis results
What spirometry data would you expect to see with obstructive and restive components?
Describe the techniques used to empty the dilated bronchi of secretions in bronchiectasis?
Brief (days to weeks)
A prolonged forced expiratory time (longer than 4 seconds) airflow limitation, is preferred to other phrases such as airway obstruction and airway narrowing that imply specific mechanisms of airflow limitation.
describes airways that narrow to easily or too much in response to a provoking stimulus.In asthma, airways can be hyper responsive to many different stimuli.
inhibiting on or more of the components of the inflammatory reaction
A protein that causes on to have an allergic reaction. Ex:include foods, animal dander, and some drugs
A protein (also called an immunoglobulin) that is manufactured by lymphocytes (a type of white blood cell) to neutralize an antigen or foreign protein. Bacteria, viruses and other microorganisms commonly contain many antigens, as do pollens, dust mites, molds, foods, and other substances. When the body forms a type of antibody called IgE (immunoglobulin E), allergic rhinitis, asthma or eczema may result when the patient is again exposed to the substance which caused IgE antibody formation (allergen)
A substance that can trigger an immune response, resulting in production of an antibody as party of the body's defense against infection and disease Many antigens are foreign proteins (those not found naturally in the body). An allergen is a special type of antigen which cause an IgE antibody response.
A comprehensive approach to achieving and maintaing contra lot asthma. It includes patient education to develop a partnership in management, assessing and monitoring severity, avoiding or controlling asthma triggers, establishing plans for medication and management of execrations, and regular followup care.
Health care professional who has received specific training in the diagnosis and management of asthma.
The propensity, usually genetic, for developing IgE-ediated responses to common environmental allergens.
Airflow limitation due to contraction of airway smooth muscle, is preferred to the word bronchospasm.The bronchi become narrowed and constricted
A group of drugs that widen the airways in the lungs
Risk factors that sensitize the airways and cause the onset of asthma symptoms. the most important of these are allergens and chemical sensitizers.
Remains for several years, possibly a lifetime
Risk factors that either augment the likelihood of asthma developing upon exposure to a risk factors or may even increase susceptibility to asthma. These factors include smoking, viral infections, low birthweight, and environmental pollutants.
Medications taken daily on a long-term basis that are useful in getting persistent asthma under control and in maintaing control. They include anti-inflammatory agents and long-acting bronchodilators. Anti-inflammatory agents, particularly inhaled corticosteroids, are at present the most effective controller medications. Controller medications are also sometimes called prophylactic, preventive, regular preventive, or maintenance medications.
A group of anti-inflammatory drugs similar to the natural corticosteroid hormones produced by the adrenal glands. Among the disorders that often improve with corticosteroid treatment are asthma, allergic rhinitis, eczema and rheumatoid arthritis
Disorder versus disease
Disorder implies a health condition with multiple causative mechanisms; disease implies a single pathology and etiology.
Removal of risk factors from the environment
Asthma that is triggered by an allergic reaction, usually something that is inhaled, or in the environment.
To aggravate or make worse. Excerbate is preferred to the words "cause", "precipitate", "induce" and "incite".
Any worsening. Onset can be acute and sudden, or gradual over several days. A correlation between symptoms and peak flow is not necessarily found. "replaces the words attack and episode"
Providing patients and their families with suitable information and training so that the patient can keep well and adjust treatment according to a medication plan developed with the health care professional.
A chemical present in cells throughout the body that is released during an allergic or inflammatory reaction. It is responsible for narrowing the bronchi or airways in the lungs during an asthma exacerbation.
Risk factor or trigger that may cause increased symptoms and/or airflow limitation.
A collection of cells and proteins that protects the body from potentially harmful, infectious microorganisms (microscopic life-forms), such as bacteria, viruses and fungi. The immune system plays a role in the control of cancer and other diseases, but also is the culprit in the phenomena of allergies, hypersensitivity and the rejection of transplanted organs, tissues and medical implants.
Also known as antibodies. Proteins found in blood and in tissue fluids. Immunoglobulins are produced by cells of the immune system called B-lymphocytes. Their function is to bind to substances in the body that are recognized as foreign antigens (often proteins on the surface of bacteria and viruses).Provoke inflammatory reaction.
Is the redness, swelling, heat and pain in a tissue due to chemical or physical injury, or to infection. Allergic reaction in the nose, lungs, and skin.
Asthma that has no apparent external cause.
Any of a group of white blood cells of crucial importance to the adaptive part of the body's immune system. The adaptive portion of the immune system mounts a tailor-made defense when dangerous invading organisms penetrate the body's general defenses.
These cells play an important role in the body's allergic response, are present in most body tissues, but are particularly numerous in connective tissues, such as the dermis (innermost layer) of skin, and also are found in the airways. Allergen exposure, the mast cells release substances such as histamine into the tissue.
Specific plan, preferably written, to achieve and maintain control of asthma based on use of controller and reliever medications in a stepwise approach. Includes instructions on how to recognize worsening of asthma and what actions to take.
The aim of patient education is guided self-management. The health care professional provides the patient and the patient's family with suitable information and training so that the patient can stay well and adjust treatment according to medication plan developed with the health care professional.
PEF (peak expiratory flow) home monitoring
Measurement of PEF on a regular basis at home with a portable peak flow meter. Home monitoring is especially useful in patients over 5years of age with moderate persistent to severe persistent asthma.
Diurnal variation in peak flow expressed by the formula. Calculations of PEF daily variability provide a reasonable index of asthma stability and severity.
Primary prevention is preventing development of the condition of asthma. Secondary prevention is preventing exacerbations of asthma in those who already have the condition and avoiding deterioration in lung function or death from the condition.
Short-acting bronchodilating medications that act quickly to relieve airflow limitation and its accompanying acute symptoms such as cough, chest tightness, and wheezing. AKA quick relief medicine or rescue medicine.
1. Development of the condition of asthma. Ex: risk factor for the onset of asthma can be inherited, such as atopy. Can be due to environmental exposure.
2. Cause asthma exacerbations in individuals who already have the conditions. These are also called triggers. Ex: dust, mites, exercise, cold, dry air.
A risk factor that causes exacerbations of asthma, a stimulus that causes an increase in asthma symptoms and/or airflow limitation.
asthma management system based on specified levels of symptoms and PEF that helps patients monitor their disease, identify the earliest possible signs that the day-to-day control of asthma is deteriorating, and act quickly to regain control.
~Short-Acting Adrenergic Bronchodilator Beta2 Agents
~Short-Acting Adrenergic Bronchodilator Beta2
~Mast Cell-Stabilizing Agents
~Short acting Adrenergic Bronchodilator Beta2
~Long acting Beta2
For Asthma in it's pure state the following will? Elastic Recoil, Residual Volume, Total Lung Capacity, FEV1, FVC, FEV1/FVC%, DLCO.
RV increased,TLC increased
FEV1 decreased,FVC decreased,ER decreased,FEV1/FVC% decreased
Stimulate sympathetic nervous system
Block parasympathetic nervous system
Mast Cell Stabilizing Agent
block calcium channel essential for mast cell degrannulate and stabilizing the cell and thereby preventing the release of histamine and related mediators.
Long acting anticholinergic
In asthma abnormal laboratory test and procedures of sputum examination ?
IgE level (elevated in extrinsic asthma)
Casts of mucus from small airways (kirschman spirals)
Beta-agonists have long been the treatment for asthma. What pathophysiological characteristic of asthma is this treatment directed?
Bronchial smooth muscle constriction
Corticosteroids have been used in the treatment for asthma. What pathophysiological characteristic of asthma is this treatment directed?
Maria is experiencing shortness of breath, while she was playing in a dusty shed at her grandparents. Which type of asthma involves reaction to a specific antigen?
Maria's asthmatic attack, has not responded to aggressive emergency room drug therapy. Her condition has progressed to what is called?
blocks parasympathetic nerve impulses; decreases oral and respiratory secretions (atropine, Artane)
examples of anticholinergic medication
Oxybutinin (Ditropan, Driptane, Lyrinel XL)
Tolterodine (Detrol, Detrusitol)
Diphenhydramine (Benadryl, Sominex, Advil PM, etc.)