Flashcards in Asthma and COPD Deck (30):
What is the dutch model?
coexistance of asthma, chronic bronchitis, and emphysema.
What are the COPDs?
- obstructive airway disease (OAD)= chronic bronchitis or emphysema
- cystic fibrosis
- peripheral airway disease
Do inhaled corticosteroids work better for asthma or COPD?
What happens if you get an exacerbation and you are a smoker?
- your pulmonary function drops by 60%
- with treatment of bronchodilators over the course of month, you will never return to normal, due to AIRWAY REMODELING.
What causes COPD?
- alpha-1 antitrypsin deficiency
- socioeconomic status (TB)
- cigarette smoke
- occupational dust and chemicals
When does acute bronchitis commonly occur and what are the symptoms?
winter time; cough and sputum production.
*get a CXR in the very young and very old to rule out pneumonia
How do you treat acute bronchitis?
- supportive only
What is a "blue bloater"?
physical appearance of a typical chronic bronchitis pt (chunky and smells of smoke).
*** What is chronic bronchitis?
mucus gland hyperplasia in response to chronic bronchial irritation, usually cigarette smoke. Excessive mucus secretion is manifested by chronic or recurrent productive cough (lasting at least 3 months a year for 2 consecutive years).
*everyone who smokes gets this.
What other features will you see with chronic bronchitis?
hypercapnea (increased CO2), frequent infections, polycythemia (increased RBCs), and possible cor pulmonale
How do you write for chronic bronchitis in order to be reimbursed by the insurance companies?
acute exacerbation of chronic bronchitis
What are the 2 most common bacteria associated with acute exacerbation of chronic bronchitis?
1. Haemophilus influenzae
2. Step pneumoniae
What is bronchiectasis?
nuclear chronic bronchitis= the airway is totally destroyed
*diagnose with chest CT scan
What is a "pink puffer"?
physical appearance of a typical emphysema pt (thing with pursed lips breathing).
What are the GOLD guidelines?
epidemiological way of figuring out where your pt stands (groups A, B, C and D)
What is the difference between centri and pan- lobular emphysema?
centrilobular= abnormal enlargement of the terminal bronchioles
- palobular= abnormal enlargement of both the terminal bronchioles and alveoli (ex. alpha-1 antitrypsin deficiency).
What is the characteristics of emphysema?
you use the elasticity of the lung (it turns into just a bag) due to cigarette smoke, air pollution, infection, or enzyme deficiency. This leads to the major symptom of dyspnea.
What are the 2 types of asthma (which itself is a COPD)?
1. extrinsic= allergic (do an IgE level).
2. intrinsic= non-allergic (behaves like COPD).
Is asthma reversible?
YES, unless it's gone too long that airway remodeling occurs.
What are the characteristics of asthma?
- cough (productive/nonproductive)
What happens during an asthma attack?
- decreased performance on PFTs
- prolonged expiratory time in relation to inspiratory time.
What is the pathology of advanced chronic asthma?
hyperinflation, thick tenacious mucus, mucus plugs and peribronchial eosinophilic infiltration
** What are the 2 phases of asthma?
1. EARLY (immediate response)= bronchospasm that occurs in all pts due to release of histamine from mast cells 5-10 mins after exposure to allergen. Lasts 1.5 to 2 hours.
2. LATE (delayed response)= inflammation in most pts and typically more severe. This occurs due to eosinophils, platelets, and neutrophils occurring 3-8 hours after exposure.
How do we treat the EARLY response to asthma?
brochodilators (beta 2 agonists)
How do we treat the LATE response to asthma?
corticosteroids or keep hitting it with bronchodilators
Do blacks or whites have more severe asthma attacks?
BLACKS (we don't know why)
What precipitates asthma attacks?
- exercise (breathing in cold air)
- pregnancy (do not let O2 sats drop below 90 or the child can get cerebral palsy).
- aspirin or non-selective beta blockers
- weather changes (cold air)
- food additives (sulfites)
What are the 4 components of asthma management?
1. objective measures
2. patient education
3. environmental control measures
What are peak flow meters?
assess severity of asthma at home or in the physicians office by detecting decreases in PEFR (peak expiratory flow rate).