Chapter 22: Asthma Flashcards
1
Q
Asthma
A
2 types
- intrinsic: non-allergic, adult onset
- Extrinsic: allergic, pediatric onset
2
Q
Extrinsic Asthma
A
- 1/3 to 1/2 of all asthma cases
- an IgE mediated response is common
- Treatment includes pharmacologic therapy, allergen specific immunotherapy, and environmental control (younger folks have extrinsic asthma that are triggered alot from the environmtent
- Bronchodilators, histamine supressors, and leukotrienes are used
3
Q
Intrinsic asthma
A
- 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 are not helpful
- sometimes people come into the hospital with this type of asthma from stress
4
Q
Exercise Induced asthma
A
- common in children and adolescents
- bronchospasm often occurs within 3 min after the end of exercise; usually resolves in 60 min
- heat loss, water loss, and increased osmolarity of the lower respiratory mucosa stimulate mediator release from basophils and tissue mast cells causing smooth muscle
- running, jogging, and tennis are the most common stimulators
5
Q
Occupational Asthma
A
- caused by exposure to chemicals
- often have positive skin test reactions to protein allergens in the work environment
- may need to conduct challenge tests
- tends to have progressively more severe exposures
- sensitization is ineffective treatment
6
Q
Drug induced Asthma
A
- can produce symptoms ranging from mild rhinorrhea to respiratory arrest requiring mechanical ventilation
- aspirin, NSAIDs can trigger attacks
7
Q
Food additives that can trigger asthma attacks
A
- tartrazine (yellow dye no 5), MSG, sodium or pottasium metabisulfite, hops in beer
- dyes used here are illegal in other countries because of their risks of cancer
8
Q
Pathogenesis of Asthma
A
- immunohistopathologic features include edema, mast cell activation, and inflammatory cell infiltration by neutrophils, eosinophils, and lymphocytes
- inflammation of the airways including acute bronchospasm (bronchoconstriction), Mucosal edema, mucus plug formation (trapping of mucous in the airway), airway wall remodeling (due to frequent asthma attack), and thickening of the basement membrane (which can lead to fibrosis)
9
Q
Pathogenesis of Allergic Asthma
Part I
A
- IgE mediated response is common
- Manifested by elevated IgE levels, allergic rhinitis (runny nose), eczema (common in alot of asthmatics), a positive family history of allergy, and attacks associated with seasonal, environmental, or occupational exposure
10
Q
Pathogenesis of Asthma (mechanism of action)
A
- exposure to a specific antigen that has previously sensitized mast cells in airway mucosa; antigen reacts with the antibody releasing chemical mediator substances
11
Q
Chemical Mediators Present with Allergic Asthma
A
- cytokines: most important inflammatory mediators
- normal respiratory epithelium replaced by goblet cells, resulting in mucosal edema, inflammatory exudates, and hyperresponsiveness of the airway (bronchoconstriction and leakage from increased microvascular permeability
- secondary mediator response occurs 6 to 12 hr later; more refractory treatment; neutrophil chemotactic factor is the likely cause
12
Q
Clinical Manifestations of Asthma*
A
- Expiratory wheezing, feeling of tightness in chest, dyspnea, cough (dry or productive), increased sputum production, hyperinflated chest, decreased breath sounds
13
Q
Clinical Manifestations of severe asthma attack
A
- cant speak in full sentences, use of accessory muscles of respiration, intercostal retractions, distant breath sounds with inspiratory wheezing, orthopnea, and agitation
- if patient is wheezing and meds are given resulting in no wheezing a look of still being sick, it means there is no air getting in at all
14
Q
Clinical Manifestations of severe asthma attack (#’s)
A
- Tachypnea: > 30 breaths/min
- Tachycardia: > 120 breaths/min
- Pulsus Paradoxus: waxing and waving of BP during inspiration
- PEFR (peak flow): Measures how well air is getting into the lungs, normal is more than 200
15
Q
Diagnosis of Asthma
A
- includes Radiographic finding, physical findings, Sputum examination, pulmonary function tests, skin testing (on young patients with extrinsic asthma), ABG (arterial blood gas), Bronchial Provocation testing, and CBC (complete blood count)(shows elevated WBCs and eosinophils)
