Respiratory Disorders: Asthma

Question 1

What is asthma?

Answer 1

chronic inflm of a/w with reversible episodes of a/w obstruction

Question 2

Asthma is closely related to _______

Answer 2

COPD

Question 3

What 2 response occur from chronic inflm of the a/w?

Answer 3

1. hyper-response

2. recurrent, reversible bronchospasm

Question 4

How are a/w hyper-responsive?

Answer 4

structures are easily irritated

Question 5

What are known triggers? What happens when encountered?

Answer 5

1. something that is known to set off an episodic a/w obstruction
2. pt will react with bronchospasm and inflm

Question 6

During a recurrent, reversible bronchospasm, the a/w is ___________ to other known _______

Answer 6

hyper-responsive

triggers

Question 7

Bronchospasm involves the spontaneous _______ of the______ _______ and remains in that state until __________ _________ subsides

Answer 7

contraction

smooth muscle

asthmatic episode

Question 8

The lumen is compromised d/t ________ _________ = ________ muscles

Answer 8

muscle hypertrophy = enlarged muscles

Question 9

What is the difference if atopic and non-atopic forms?

Answer 9

Atopic = allergic conditions/disorders that are genetically based due to a genetic component

Non-Atopic = conditions/disorders similar to allergies that not genetically based

Question 10

Atopic form is also known as _________ from?

Answer 10

Extrinsic Form

Question 11

T or F: Non-Atopic is Extrinsic form

Answer 11

FFFFFFF!!!!!!

IINTRINSIC

Question 12

Give an example of extrinsic form (atopic)?

Answer 12

allergic rhinitis, asthma, and atopic dermatitis (eczema)

Question 13

Atopic form is typically associated with heightened ______ ________ to common ______ esp _______ allergens and _____ allergies

Answer 13

IR

allergens

inhaled

food

Question 14

Asthma is largely _____ b/c there is type 1 ________

Answer 14

atopic

hypersensitivity

Question 15

Etiology of Asthma (3)

Answer 15

1. complex trait
2. hypersensitivity to stimuli
3. T2H cell differentiation

Question 16

What is the complex trait etiology?

Answer 16

genetic component and environmental factors

Question 17

Hypersensitivity/Hyper-response is related to ________ component. Pt w/ asthma are hypersensitive to triggers such as _____, strong _____, _____, and a/w _______.

Answer 17

genetic

allergens, strong odours, exercise/exertion, and a/w irritants

Question 18

How does exercise trigger an asthmatic episode with inhaling an allergen? How does it present (2)?

Answer 18

places an increase burden in the compromised respiratory system

SOB and respiratory distress

Question 19

Explain how T2H cell differentiation cause Asthma?

Answer 19

During differentiation of T cells, more T2H are formed than T1H cells in asthma.

Question 20

Function of T2H vs T1H cells?

Answer 20

T2H cells: responds to allergens and intestinal parasites by stimulating differentiation of B cells into IgE-producing plasma cells acting as growth factors for mast cells and activating more eosinophils

T1H cells: responds to microbes and stimulate the differentiation of B cells into IgG- and IgM producing plasma cells

Question 21

In an infection, what is the function of macrophage and T cells?

Answer 21

engulfs foreign microbe and presents to T cells

T cells produce clones to target bacteria

Question 22

In respiratory infection , there is a shift to more _____ cells

Answer 22

T1H

Question 23

In patho: the trigger –> increase _______—> 2 phase response. What are the phase called?

Answer 23

hypersensitivity

early phase and late phase

Question 24

Fig 29.6: What happens in the early phase?

Answer 24

Allergens trigger T helper cells –> IgE are produced –> IgE binds to mast cells –> mast cells get sensitized and release mediators–> causing BRONCHOSPASM (parasympathetic receptors)

Question 25

In early phase, symptoms develop within ____-____ mins but can be inhibited/reversed by ______ such as __ _______ agonists

Answer 25

10-20 bronchodilators Beta-2 adrenergic

Question 26

What are the effects of chemical mediators in early phase (3)?

Answer 26

1. increase mucus secr. 2. increase mucosal intercellular junctions 3. bronchoconstriction

Question 27

What are the consequence of increased mucosal intercellular junction?

Answer 27

allows antigen (allergens) and sensitized mast cells to enter the submucosa into the muscle layers which are also impacted by bronchospasm

Question 28

Fig 29.6: What happens in the late phase?

Answer 28

allergens move into submucosa causing influx of inflm cells --> release more inflm mediators --> exacerbates bronchospasm and bronchoconstriction

Question 29

In late phase, what injuries occurs in submucosa layer (5)

Answer 29

1. edema 2. epithelial cell injury 3. decreased mucociliary function 4. accum. of mucus 5. increased a/w responsiveness

Question 30

An individual suffers an asthmatic episodes from cig smokes and move out of building and inhale cool air the episode does not subside. WHY?

Answer 30

In late phase, there is an increase a/w responsiveness therefore a/w is hyper-responsive to new triggers eg cool air

Question 31

The late phase develops within ____-____ hours after exposure an asthmatic trigger.

Answer 31

4-8

Question 32

What are the symptoms of early phase (7)?

Answer 32

1. type 1 H 2. allergen binds to IgE on mast cells --> mediators --> inflm 3. intercellular junctions open --> allergen enter submucosa 4. increase permeability and mucus hypersec--> edema of a/w 5. bronchospasm 6. dyspnea and wheezing 7. bronchoconstriction

Question 33

What is the duration of early response? How can relieve it?

Answer 33

less than 1 hour a puffer

Question 34

Why is there an increase in permeability? and How?

Answer 34

inflm --> increase prod of mucus-->inflm cell release mediators--> mediators results in hyperemia and vasodilation

Question 35

Dyspnea and wheezing is present in severe ___________ ________

Answer 35

respiratory distress

Question 36

How is bronchoconstriction a compensatory mechanism? Give example

Answer 36

inhaled allergen (eg noxious fumes) cause bronchoconstriction b/c it prevents inhalation of more allergens

Question 37

In the late phase, what 2 things happen when there is an influx of inflm cells?

Answer 37

1. decrease mucociliary blanket function | 2. a/w become hyper-responsive

Question 38

Late response is in ____% of all cases and may last for ____ or _____ as it is a ____-_________ cycle of _______________

Answer 38

50% days or weeks self-sustained exacerbation

Question 39

In late phase, a/w is responsive to ____ _______ and it is ________ and _____

Answer 39

responsive to new triggers frequent and severe

Question 40

Which receptors cause bronchodilation when activated? What type of drugs and example?

Answer 40

beta adrenergic receptors beta adrenergic agonists eg anticholinergic and ipratropium

Question 41

Which receptors cause Bronchoconstriction when activated? What type of drugs and example?

Answer 41

alpha adrenergic receptors alpha adrenergic agonists eg. adrenaline (Epinephrine)

Question 42

________ _____ or _____ regulates the a/w smooth muscles. It is a _____ in many __________ processes in the body

Answer 42

Cyclic AMP or cAMP mediator physiological

Question 43

Theory suggests that asthma is d/t l/o _____ _______ ___________. There is a proposed problem with the ______ _________.

Answer 43

beta receptors stimulation beta receptors

Question 44

Manifestations of Asthma (5)

Answer 44

1. dyspnea 2. wheezing and coughin 3. bronchospasm 4. increase respiratory effort 5. Abn ABG profile

Question 45

What is the coughing type?

Answer 45

productive cough

Question 46

What 3 signs of increase respiratory effort?

Answer 46

1. nasal flaring: nostrils open wide in effort to breathe 2. purse-lip breathing: tunnel made with lips to suck in and breathe out air 3. use of accessory muscle

Question 47

What does the abn ABG profile indicate (2)?

Answer 47

1. hypoxemia | 2. hypercapnia

Question 48

Diagnostic of Asthma (4)

Answer 48

1. hx and px 2. labs 3. PFT 4. Inhalation challenge test

Question 49

What is the inhalation challenge test?

Answer 49

To determine the allergen and trigger, the individual inhale potential allergens to confirm dx.

Question 50

What is a mucus plug?

Answer 50

Resembles the cast of respiratory tree of larger bronchus to finer a/w. It is expectorated in asthmatic attack. It is gel like.

Question 51

Treatment of Asthma (2)

Answer 51

1. shift from episodic to long term management to prevent episode of asthma 2. preventative: - avoid allergens and trigger - no smoking

Question 52

How many steps are in the stage based approach of drugs?

Answer 52

4 Stages

Question 53

What is stage 1 of stage based approach of drugs? route?

Answer 53

Step 1 = short acting bronchodilators --> inhaled PRN eg puffers and inhalers

Question 54

What is stage 2 of stage based approach of drugs? Why?

Answer 54

Add inhaled steroids to decrease inflm (localized effect)

Question 55

What is stage 3 of stage based approach of drugs?

Answer 55

add long acting bronchodilators

Question 56

What is stage 4 of stage based approach of drugs? What 2 drugs are used ?

Answer 56

- Steroids PO short course: oral steroids for a week to deal with acute onset of inflm AND - add 3rd drug to short acting bronchodilators, long-acting bronchodilators, and PO steroids Examples = leukotriene receptor antagonists and theophylline

Question 57

T or F: Theophylline is a first line drug

Answer 57

F!!!!!!! last line drug (not used earlier on in disease)

Question 58

What is the function of theophylline? Blood levels are required to achieve _______ dose not _____.

Answer 58

acts by relaxing bronchial smooth a/w therapeutic toxic

Question 59

What is leukotrienes? What do leukotriene receptor antagonists do?

Answer 59

- A compound in the body that mediates inflm and allergic response to get the process going. - leukotriene receptor antagonist inhibit the binding of the compound and minimizes inflm and allergic response