Ch. 22

Question 1

Etiology of Asthma:

Answer 1

Airway obstruction that is reversible (not completely in some patients). Airway inflammation: Acute bronchospasm (bronchoconstriction) and Mucosal edema, mucous plug formation

Question 2

Extrinsic Asthma

Answer 2

1/3 to ½ of asthma cases
An IgE-mediated response is common
Intermittent vs persistent

Question 3

Non-Allergic Asthma

Answer 3

Develops in middle age with less favorable prognosis
No history of allergies
Respiratory infections or psychological factors appear to be contributory
Allergen-specific immunotherapy and environmental control not helpful

Question 4

Exercised Induced Asthma

Answer 4

Common in children and adolescents
Bronchospasm often occurs within 3 minutes after the end of exercise; usually resolves in 60 minutes
Running, jogging, and tennis are the most common stimulators

Question 5

Occupational Asthma

Answer 5

Often have positive skin test reactions to protein allergens in the work environment
Tends to have progressively more severe attacks with subsequent exposures

Question 6

Drug Induced Asthma

Answer 6

Can produce symptoms ranging from mild rhinorrhea to respiratory arrest requiring mechanical ventilation
Aspirin, NSAIDs can trigger attacks

Question 7

Pathogenesis: Allergic Asthma

Answer 7

Manifested by elevated IgE levels
Associated with allergic rhinitis, eczema, a positive family history of allergy
Chemical mediators are released in response to allergen

Question 8

Clinical Manifestations of Asthma

Answer 8

Wheezing
Feeling of tightness of chest
Dyspnea
Cough (dry or productive)
Increased sputum production (thick, tenacious, scant, and viscid) 
Hyperinflated chest
Decreased breath sounds

Question 9

Clinical Manifestations of SEVERE Asthma Attack

Answer 9

Use of accessory muscles of respiration
sternocleidomastoid, scalenes
Intercostal retractions
Distant breath sounds with inspiratory wheezing
Orthopnea
Agitation
Tachypnea: >30 breaths/min
Tachycardia: >120 beats/min
Wheezing is NOT a good indicator of air flow

Question 10

Asthma Treatment

Answer 10

Avoid triggers
Environmental control
Dust control, removal of allergens, air purifiers, air conditioners
Preventive therapy
Stop smoking, avoid second-hand smoke, aerosols, odors, early treatment for respiratory infections
Desensitization (allergen specific immunotherapy)
Medications

Question 11

Acute Bronchitis Etiology

Answer 11

Acute inflammation of the trachea and bronchi
Causes
Viral or nonviral
Heat
Smoke inhalation
Inhalation of irritant chemicals
Allergic reactions

Question 12

Acute Bronchitis Pathogenesis

Answer 12

Airways become inflamed and narrowed
Swelling
Increased mucus production
Loss of ciliary function

Question 13

Acute Bronchitis Clinical Manifestations

Answer 13

Usually mild and self limiting
Cough (productive or nonproductive)
Low-grade fever
Substernal chest discomfort
Sore throat
Postnasal drip
Fatigue

Question 14

Acute Bronchitis Treatment

Answer 14

Usually no treatment needed for viral 
Antibiotic therapy (bacterial)
Codeine-containing medications (for cough)
Increase fluid intake
Avoid smoke
Use a vaporizer in bedroom

Question 15

Chronic Bronchitis Etiology

Answer 15

Type B COPD, “blue bloater”
Hypersecretion of bronchial mucus
Chronic or recurrent productive cough >3 months >2+ successive years
Persistent, irreversible when paired with emphysema
1:2 male to female ratio
>30 to 40 years

Question 16

Chronic Bronchitis Pathogenesis

Answer 16

Chronic inflammation and swelling of bronchial mucosa scarring
Hyperplasia of bronchial mucous gland/goblet cells  mucus
Increased bronchial wall thickness
Resistance increases work of breathing and O2 demands
Pulmonary hypertension
Inflammation in bronchial walls with vasoconstriction of pulmonary vessels and arteries
Right-sided heart failure may occur due to high pulmonary resistance
Destruction of bronchial walls
Results in dilation of airway sacs
Dilated sacs contain pools of infected secretion that do not clear themselves  further infection

Question 17

Chronic Bronchitis Treatment

Answer 17

Goals
Block the progression of the disease
Return to optimal respiratory function
Return to usual activities of daily living
Medications
Inhaled short-acting B2 agonists
Inhaled anticholinergic bronchodilators
Cough suppressants
Antimicrobial agents (bacterial infections)
Inhaled/oral corticosteroids

Low-dose O2 therapy
Smoking cessation

Question 18

Emphysema Etiology

Answer 18

Type A COPD
“Pink puffer”
Destructive changes of the alveolar walls
Abnormal enlargement of the distal air sacs
Damage is irreversible
Associated with chronic bronchitis

Question 19

Emphysema Pathogenesis

Answer 19

Smoking causes alveolar damage
Inflammation leads to release of enzymes that inactivate a substance that normally protects lung tissue
Exchange of O2 and CO2 between alveolar and capillary blood impaired
Loss of elastic tissue in lung
Air becomes trapped in distal alveoli
Loss of alveolar wall and air trapping leads to bullae (large, thin-walled cysts in the lung) formation

Question 20

Emphysema Clinical Manifestations

Answer 20

Progressive, exertional dyspnea
Thin 
Due increased respiratory effect, increased caloric expenditure, and decreased ability to consume adequate calories
Use of accessory muscles
Pursed-lip breathing
Cough (minimal or absent)
Digital clubbing
Barrel chest

Question 21

Emphysema Treatment

Answer 21

O2 therapy
Smoking cessation
Medications
Inhaled short-acting B2 agonists
Inhaled anticholinergic bronchodilators
Cough suppressants
Antimicrobial agents (infections)
Inhaled/oral corticosteroids
Theophylline products

Question 22

Pulmonary Function Test (PFT)

Answer 22

Demonstrates obstruction of airflow in lungs
Spirometry
Determines severity and diagnosis of COPD
Patient inhales deeply and exhales as quickly as possible until maximal air is exhaled
Forced vital capacity (FVC)
Total volume of air exhaled
Time required for exhaling the air is also measured
Forced expiratory volume in 1 second (FEV1)
Volume exhaled in 1st second is reliable index of obstructive airway disease

Question 23

Bronchial Provocation Test

Answer 23

Controlled induction of bronchospasm by inhalation of various agents; then ventilations measured