Class 23 review

Question 1

Asthma

Answer 1

Asthma is a chronic inflammatory disorder of the airways. When the airways become inflamed, some obstruction of airflow occurs and we will see symptoms like breathlessness, coughing, wheezing, chest tightness. The airways become hyper-responsive to certain triggers that can bring on an asthma attack.

Question 2

Diagnosis of asthma

Answer 2

spirometry

Question 3

exacerbation

Answer 3

When a person with COPD has a sudden increase in symptoms. Symptoms are worse for a period of time and then may improve. Exacerbations are often precipitated by respiratory illness such as colds, pneumonia and influenza. Exacerbations of COPD are frequently the cause of hospitalization. Dyspnea, cough, sputum

Question 4

Asthma triggers

Answer 4

Allergens
Exercise
Respiratory infection
Nose & sinus problem
Drugs (NSAIDS, beta blockers)
GERD
Air pollutants
Emotional stress

Question 5

Early phase response of asthma

Answer 5

Bronchospasm. Increased mucus secretion, edema formation, and increased amounts of sputum
30-60 min

Question 6

Late phase response of asthma

Answer 6

Primarily inflammation
Peaks 5-12 hrs
Corticosteroids are effective in preventing and reversing this cycle
If not treated, may lead to irreversible lung damage

Question 7

Asthma clinical picture

Answer 7

Obstruction & air trapping
Dyspnea & chest tightness
Speech 1-2 words
Anxiety, distress
Tachycardia
Initially low O2 low CO2

Question 8

SABAs - Inhaled

Answer 8

B-Adrenergic agonists

• prevent release of inflammatory mediators from mast cells
• SABAs not for ongoing long-term use
• onset of action in minutes and duration of 4-8 hr

Question 9

SABAs example

Answer 9

Salbutamol (Ventolin)

Question 10

LABAs - Inhaled

Answer 10

• long-acting: take q12h
• used for long-term control asthma
• control - not a rescue inhaler
• works by same mechanisms as SABAs
• can be combined with inhaled corticosteroid (ICS) (fluticasone)

Question 11

LABAs example

Answer 11

Salmeterol (Serevent diskus)

Question 12

Anticholinergic - Inhaled

Answer 12

• block action of acetylcholine
• usually used in combination with another bronchodilator
• most common adverse effect is dry mouth

Question 13

Anticholinergic example

Answer 13

Ipratropium (Atrovent)

Question 14

Methylxanthines

Answer 14

• less effective long-term bronchodilator
• controller after trying ICS, LABA, and LTRAs
• Narrow toxic/ therapeutic ratio and frequent adverse events

Question 15

Methylxanthines example

Answer 15

Theophylline

Question 16

Corticosteroids

Answer 16

• decreases inflammation in airways by suppressing immune response
• reduce bronchial hyper-responsiveness
• decreases mucus production
• are taken on a fixed schedule
• oropharyngeal candidiasis, hoarseness, and a dry cough are local adverse effects of inhaled drug
• adverse effects can be reduced by a spacer or gargling after use
• taken daily, not a rescue drug

Question 17

Corticosteroids examples

Answer 17

Inhaled: fluticasone (Flovent)
Systemic: prednisone

Question 18

Leukotriene modifiers or inhibitors

Answer 18

• block action of leukotrienes - which are potent bronchoconstrictors
• have both bronchodilator and anti-inflammatory effects
• not indicated for acute attacks
• used prophylactic and maintenance therapy
• taken daily not a rescue drug

Question 19

Leukotriene modifiers or inhibitors example

Answer 19

montelukast (Singulair)

Question 20

Mast cell stabilizers

Answer 20

• alternative to corticosteroids if needed
• inhibits release of histamine from mast cells to reduce inflammation
• may cause local irritation in nose, mouth, throat
• taken daily not a rescue drug

Question 21

Mast cell stabilizers example

Answer 21

Cromolyn

Question 22

COPD

Answer 22

Chronic obstructive pulmonary disease

• disease caused by smoking 80-90%
• progressive partially reversible airflow obstruction
• increasing frequency & severity of exacerbations
• characterized by chronic inflammation found in the airways, lung parenchyma, and pulmonary blood vessels

Question 23

COPD risk factors

Answer 23

Cigarette smoking
Occupational chemicals and dust
Air pollution
Infection
Heredity
Aging

Question 24

COPD and smoking

Answer 24

• COPD ~ age 50 or ~20 pack years
• 15% of smokers develop clinically significant airway obstruction
• 80% to 90% of COPD deaths are related to tobacco smoking

Question 25

Emphysema

Answer 25

Destruction of alveoli and permanent enlargement of airways without fibrosis

Question 26

Chronic bronchitis

Answer 26

Over-secretion mucous and chronic productive cough that lasts more than 3 months for a minimum 2 years in a row

Question 27

COPD pathophysiology

Answer 27

Air is trapped inside the lungs which causes hyperinflation and overexpansion Mucus hyper secretion Airflow limitation Loss of elastic recoil Pulmonary hypertension

Question 28

COPD clinical manifestations

Answer 28

Underweight with adequate caloric intake Anorexia Chronic fatigue Bluish-red colour of skin - polycythemia and cyanosis Prolonged expiratory phase Wheezes Decreased breath sounds Barrel chest

Question 29

Answer 29

Question 30

Cor Pulmonale pathophysiology

Answer 30

Hypertrophy of right side of heart * Result of pulmonary hypertension * Late manifestation of chronic pulmonary heart disease * Eventually causes right-sided heart failure

Question 31

Cor Pulmonale symptoms

Answer 31

Dyspnea Distended neck veins Hepatomegaly with rihgt upper quadrant tenderness Peripheral edema Weight gain Ascites Epigastric distress

Question 32

Salbutamol (Ventolin)

Answer 32

Short acting: 3-5 hourss Activate beta 2 adrenergic receptors in the pulmonary smooth muscle, causing bronchodilation. Also may suppress histamine release

Question 33

Salmeterol (Serevent diskus)

Answer 33

Long-acting: 12 hours Used for long-term control of chronic COPD. Works by same mechanism as SABAs

Question 34

Ipratropium(Atrovent)

Answer 34

Short-acting muscarinic antagonist (6 hours) Blocks muscarinic receptors in the bronchi, which decreases and prevents further bronchoconstriction

Question 35

Tiotropium (Spiriva)

Answer 35

Long-acting muscarinic receptor (24 hours). Works in the same mechanism as Ipratropium but is more effective

Question 36

ICS Fluticasone (Flovent) or Beclomethasone

Answer 36

Decreases inflammation in airways by suppressing immune response. Not to be used alone in COPD, used with a LABA.

Question 37

Asthma diagnosis

Answer 37

test for reactivity Methacholine Challenge (histamine) Exercise Challenge Drop by 15 – 20% of FEV1 indicates hyper-responsive airways * Allergy testing * Sputum eosinophils * Sputum culture and sensitivity

Question 38

COPD diagnosis

Answer 38

test for obstruction Reduced FEV1/FVC ratio Increased residual volume COPD is diagnosed when FEV1/FVC is less than 70% predicted * Walk test (6 min.) to determine O2 desaturation in the blood with exercise * ECG can show signs of right ventricular failure

Question 39

Carbon dioxide Narcosis

Answer 39

a tolerance for high levels of carbon dioxide and development of a “hypoxic drive” to breath Monitor: cognitive changes and physical assessment

Question 40

Oxygen Toxicity

Answer 40

high concentrations of oxygen can damage alveolar-capillary membranes

Question 41

Absorption Atelectasis

Answer 41

high oxygen washes out nitrogen from alveoli → alveolar collapse