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S2 MAP II > Asthma and Cystic Fibrosis > Flashcards

Asthma and Cystic Fibrosis Flashcards

1
Q

obstructive pulmonary disease

  • what happens
  • types
A

air get trapped in the lungs
types
-nonseptic obstructive diseases
-septic obstructive pulmonary diseases

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2
Q

nonseptic obstructive disease examples

A

emphysema
asthma
chronic bronchitis

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3
Q

septic obstructive pulmonary disease examples

A

cystic fibrosis

bronchiectasis

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4
Q

restrictive pulmonary disease

  • what happens
  • result…
A

loss of lung compliance and chest wall expansion

decreased depth and increased rate of breathing

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5
Q

asthma

-obstructive or restrictive

A

obstructive

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6
Q

asthma

  • characterized by…
  • risk factors
A 
characterized by REVERSIBLE obstruction to airflow within the lungs
risk factors
-childhood asthma
-family history
-atopy
-maternal smoking
-occupational exposure
-environmental exposures
-secondary smoke
-gender
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7
Q

asthma associations

  • increase in families with…
  • of children with asthma (what were associated conditions)
A

increased in families with asthma or allergies
of children with asthma
-77% had allergic rhinitis
-17% eczema
-91% family history of allergy in 1st degree relative

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8
Q

asthma

-US prevalence

A

most common chronic childhood disease
6.5 million under age 18 with ashtma
>4000 deaths/year
ethnic differences in asthma prevalence, morbidity and mortality are highly correlated with poverty, urban air quality, indoor allergens, and lack of patient education and inadequate medical care

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9
Q

S/S of asthma

A

wheezing
-high-pitched whistling sounds when breathing out - especially in children
cough, worse particularly at night
recurrent wheeze
recurrent difficulty in breathing
recurrent chest tightness
Sx occur or worsen at night, awakening the patient

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10
Q

asthma Sx occur or worsen in the presence of…

A 
exercise
viral infection
animals with fur or hair
house-dust mites
mold
smoke
pollen
changes in weather
strong emotional expression (laughing or crying hard)
airborne chemicals or dusts
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11
Q

key components of asthma

A

bronchoconstriction
swelling
mucus plug

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12
Q

asthma pathophysiology

A

intermediate type hypersensitivity reaction
mast cells release histamine
cells of immune system stimulate airway

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13
Q

intermediate type hypersensitivity reaction

-results in…

A

direct stimulation of airway muscle

indirect stimulation by mediator-secreting cells

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14
Q

asthma pathophysiology: cells of immune system stimulate airway

  • acute effects
  • chronic effects
A 
acute
-inflammation: increased capillary permeability
-smooth muscle contraction
chronic
-mucus production
-inhibition of mucociliary clearance
-airway changes
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15
Q

bronchial sensitivity: triggers

-examples

A

allergens
-pollen, animal dander, dust mites, cockroaches
irritants
-irritating substances (smoke, pollution, odors), sulfites (dried fruit, wine)
other
-weather/environmental
-exercise

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16
Q

asthma: results of inflammation

A

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

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17
Q

which measures are used to assist with diagnosing asthma

A 
FVC
FEV1
FEV1/FVC
FEF25-75
-average rate of flow at mid-exhalation
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18
Q

diagnosis of asthma

A

spirometry to establish airway obstruction

post-bronchodilator response - primary test to diagnose asthma

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19
Q

airway obstruction measures for a diagnosis of asthma

A

FEV1 < 80% predicted

FEV1/FVC < 65% of predicted

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20
Q

in terms of reversibility with asthma, what do we want the FEV1 to do after short acting beta2-agonist

A

FEV1 increases > 12% with >/= 200 ml change

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21
Q

asthma: other diagnostic tests (other than post-bronchodilator response)

A

exercise challenge

methacholine challenge

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22
Q

asthma classification severities

-what features are looked at

A 
severe persistent
moderate persistent
mild persistent
mild intermittent
classified according to their most severe feature
-days with Sx
-nights with Sx
-PEV or FEV1
-PEF variability
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23
Q

common medications used to treat asthma

A

albuterol
atrovent
salmeteral (Serovent)
inhaled steroids

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24
Q

albuterol

  • MOA
  • onset
  • duration
A 
B2 selective bronchodilator
onset
-5-15 minutes
duration
-3-6 hours
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25
Q

atrovent

  • MOA
  • onset
  • duration
A 
MOA
-anticholinergic, prevents bronchoconstriction
onset
-15 minutes
duration
-3-4 hours
26
Q

salmeteral

  • MOA
  • onset
  • duration
A 
B2 bronchodilator
onset
-10-20 minutes
duration
-12 hours
27
Q

pharmacotherapy: persistent asthma needs 2-step process

A 
long-term control
-steroids, leukotriene antagonists
-long active beta agonist
acute exacerbations
-albuterol or short acting best agonist
28
Q

asthma

-what is stepwise control

A

need a baseline

need inhaler with you

29
Q

asthma treatment guidelines

-focus on what components of asthma care

A

measures to assess and monitor asthma
patient education
control of environmental factors and other conditions that can worsen asthma
medications

30
Q

asthma: periodic assessment components

A

teach all patients with asthma to recognize symptoms that indicate inadequate asthma control
patients should be seen by a clinician at least every 1-6 months

31
Q

asthma: patient education

A

self-monitor and manage
asthma action plan
-daily strategies and exacerbations
new settings include pharmacies, community centers

32
Q

asthma comorbidities

A

obesity
sinusitis
GERD
sleep apnea

33
Q

long-term consequences of asthma

A 
hyperexpansion of thorax
postural changes
decreased physical fitness
school absence
restricted physical activity
change in family-social systems
increased hospitalizations
34
Q

effect of breathing exercise on asthma

A

FEV1 and FVC showed non-significant results
PEFR showed significant improvement
decreased rescue beta agonist use
reduced corticosteroid use

35
Q

EIA

-incidence

A

3-10%
35-50% incidence in cold weather athletes
-figure skater, ice hockey, nordic skiing

36
Q

factors most likely to cause EIA

A

continuous hard exercise
exercise in cold environment
exercise in polluted air
exercise in pollen season for allergic athletes
exercise during upper respiratory infection

37
Q

PT treatment implications for asthma

A

pre-treat with beta agonist before exercise
measure peak flow before and after exercise
listen for wheezing before and after exercise
early and longer warm-up period
increase humidity in exercise area
have patient breathe through nose
short exertion periods (intermittent exercise) may decrease need for medications

38
Q

physical training and asthma

A

physical training is well tolerated among people with asthma in the included studies

39
Q

cystic fibrosis

-what is it

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

40
Q

cystic fibrosis transmembrane conductance regulator (CFTR) gene

  • what is it
  • what happens to it in CF
A

normally opens channel through plasma membrane of cell to allow chloride to pass through
in defective gene
-faulty salt movement of Na+ and Cl-

41
Q

what is the initial test for CF

-why?

A

sweat test

sweat glands will produce saltier secretions

42
Q

CFTR gene and airways

A

the CFTR protein regulates channels that allow the Cl- ions to exit airway cells
normally, Na+ ions follow the Cl-, and the NaCl combination pulls out water to line the airway with fluid
in CF cells, the defective CFTR protein blocks the Cl channels, so too much sodium and water are pulled into the cell, leaving behind dry mucus

43
Q

consequences of defective CFTR

A

in healthy lungs, the fluid lining the airway traps potentially harmful substance, and the cilia beat in a coordinated manner to sweep the foreign substances out
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

44
Q

intestinal blockage with CF

A

since salt and water stay in the cells, there is less water in the intestines

45
Q

effect of CF on pancreas

  • function when healthy
  • what changes with CF
A

pancreative enzymes help break down proteins, fats, and carbs
in CF
-epithelial dysfunctiion
-pancreatic enzymes do not cross cell membrane
-also get mucus blocks

46
Q

consequences of CF

A

severe lung infections
decreased release of pancreatic enzymes
-poor nutrition
reproductive blockage

47
Q

additional consequence of CF

A

oxygen deprivation

-clubbed fingers: sign of hypoxemia (poor gas exchange)

48
Q

common pulmonary infections

  • what are they
  • how are they transmitted
  • how do they colonize
A

staphylococcus aureus
-early
pseudomonas aeruginosa
-primary
transmitted by respiratory or hand contact
usually colonize in lungs and difficult to eradicate

49
Q

explain bronchiectasis

A

mucus production increases, the cilia are destroyed or damaged, and areas of the bronchial wall become chronically inflamed and are destroyed

50
Q

treatment of pulmonary infections

A

inhaled bronchodilator
mucolytics
airway clearance
-AD or ACB (autogenic drainage; active cycle of breathing)
-ThAirapy Vest
-NEED TO COUGH AFTER THESE TREATMENTS TO REMOVE MUCUS
antibiotics

51
Q

pulmonary medications

A

beta agonist bronchodilators
Pulmozyme
guaifenesin

52
Q

Pulmozyme

  • function
  • MOA
A

inhaled medication that thins mucus

acts by breaking down DNA in sputum and thinning secretions

53
Q

Guaifenesis

-function

A

oral medication that thins mucus

54
Q

pulmonary infection antibiotics

A

aminoglycosides
inhaled tobramycin TOBI
azithromycin

55
Q

new pharmacoloy therapies for pulmonary infections

A

Ivacaftor

-CFTR potentiator

56
Q

rheumatoid diseases in patients with CF

A

cystic fibrosis arthropathy
hypertrophic arthropathy
osteoporosis

57
Q

CF arthropathy

  • prevalence
  • S/S
  • radiograph findings
  • occurs with…
  • may respond to…
A

8-10% of CF
S/S
-recurrent, painful mono or poly-arthritis
-erythema nodosum rash
normal radiograph or joint effusion
occurs with late pulmonary or pancreatic manifestations
may respond to NSAIDs

58
Q

hypertrophic pulmonary osteoarthropathy (HPOA)

  • prevalence
  • linked with…
  • Sx of…
  • possible abnormal…
  • treated with…
A 
occurs in 2-7% of CF adults
linked with disease severity
Sx of
-finger clubbing
-chronic inflammation (periostitis) of long obnes
-joint inflammation of wrist, knee, ankle
possible abnormal platelet function
treated with NSAIDs
59
Q

if having an individual with CF exercise, what do you need to be prepared to do

A

facilitate the removal of dislodged mucus

60
Q

what are components of effective CF treatment

A 
exercise
breathing training
monitor
airway clearance
educate

S2 MAP II (17 decks)

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