Term
| 4 irritants cause Inflammation in the Lung |
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Definition
Irritants:
1. cigarette smoke
2. pollutants
3. infections
4. chronic immunologic stimulation |
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Term
| explain the Pathophysiologic Response of inflammation of lung |
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Definition
Inflammatory goblet cell metaplasia of the bronchiolar epithelium
Increased mucosal edema
narrowing of the airways
increase production of excessive, thick secretions or mucus
Results: loss of ciliated epithelium, squamous metaplasia, and eventual peribronchial fibrosis |
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Term
Asthma is Obstructive Airway Disease
with what 3 components? |
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Definition
Inflammation
Airway hyper-responsiveness
Allergic or Immunologic Mediated |
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Term
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Definition
| Asthma has been defined as an inflammatory disease of the lung that is largely reversible in character. |
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Term
| Is asthma an Epidemic in the US? |
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Definition
YES . The CDC and NIH now consider these facts as evidence of a true epidemic within our nation, and the world
because Continued increase in diagnosis within all ages
especially pre-school children
Young Adult onset
Continued increase in morbidity despite improved understanding and management of the disease |
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Term
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Definition
Continued increase in diagnosis within all ages
especially pre-school children
Young Adult onset
Continued increase in morbidity despite improved understanding and management of the disease |
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Term
| what is status asthmaticus? |
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Definition
Status asthmaticus refers to severe bronchospasm that does not respond to aggressive therapies
within
30 to 60 minutes |
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Term
| on the physical exam how do you know if that asthma is Mild moderate or severe. |
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Definition
Make sure you look at the pt first
physical appearance and RR
Is the Patient Able to Speak?
Mild = sentences
Moderate = phrases
Severe = words
cyanosis is uncommon, WHY??? left shift of the oxyhemoglobin dissociation curve produced by respiratory alkalosis, WHY??? |
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Term
in PMH and Personal Hx would find this ---true or false
Pre-term infant? Required a tube to breathe at birth?
Hx of Asthma or “recurrent bronchitis”?
Wheezing or whistling when breathing?
Wheezing or whistling when exercising?
Cough during or after exercising/exertion?
Smoking? Tobacco/marijuana?
Drink alcohol, and visit strip clubs QD.
Occupational exposures? Coal miner? Cleaners? Military? |
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Definition
| except Drink alcohol, and visit strip clubs QD. everything is true...remember that |
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Term
| know the PE associated with asthma from PP. cant put every little thing in here buddy |
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Definition
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Term
Dx option for Asthma?
what kind of x-ray result would you get for asthma? |
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Definition
Pulse Oximetry: indicates acute oxygenation status
Pulmonary function studies: PFT’s are standard, get the FEV1 or the PEFR
CXR:
looks for diagnostic indicators
Usually normal in “pure” acute asthmatic |
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Term
Give some info about Labs value in ASthma
SpO2?
CBC?
BNP?
Electrolytes?
ABG? |
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Definition
Pulse Oximetry: desired range above 98%
CBC with differential
WBC count:
Leukopenia (decreased): immunosuppressed
Leukocytosis (increase):
infection
Corticosteroids
BNP: only if your asthmatic might have CHF
Electrolytes: usually normal unless severe
ABG’s:
Not usually routine, doesn’t dictate “intubation vs no intubation”
Good “IF” you cannot get a reliable Pulse Ox |
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Term
this was in her notes...
1/6 of the droplet of HCL would cause cough. GERD would initiate asthma. Beta agonist could cause GERD |
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Definition
| that Sucks screwed both ways..lol... |
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Term
| when do you give epinephrine ? side effects |
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Definition
Epinephrine injection/IM if not responding
Cardiovascular system:
Heart Rate increase,
Blood pressure increase
Pulmonary system:
Respiratoy Rate decrease due to broncho-dilation
Intubation if Respiratory Failure |
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Term
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Definition
OXYGEN (must perfuse the vital organs)
ye O2 is not B2 but give it anyways
Inhaled short acting B2-agonist:
Albuteral
Proventil
Ventolin
ProAir
Levalbuterol (Xopenex) short acting
general rule: for adults, not children <6 Y.O |
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Term
| this is a good COPD drug and used for relaxation of larger airways.--- hint not steroids |
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Definition
Ipatropium bromide(Atrovent)
Use up to QID, (unless doing Duonebs)
Atrovent is for relaxation of LARGE airways
Good for COPD patients |
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Term
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Definition
Systemic corticosteroids
prednisone
40-80mg day (1mg/kg day)
max 2mg/kg/day |
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Term
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Definition
Magnesium sulfate: NOT for mild to moderate asthma, SEVERE only or pregnant women.
What is the theory behind magnesium sulfate…?? (relaxation of smooth muscles)
In type I diabetes, ketoacidosis causes sinusitis by Mucormycosis |
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Term
| common cough up all "the rule of Twos" 5 of them |
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Definition
Two beta-agonist canisters/year
Two doses of beta-agonists/week
Two nocturnal awakenings/month
Two unscheduled visits to Dr./year
Two prednisone bursts/year |
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Term
| __________________ have been found to be the most effective long-term therapy available for patients with mild, moderate, or severe persistent disease activity in all ages” |
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Definition
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Term
Just inhaled steroids-- name 6 of them
3A,FPQ |
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Definition
Pure Steroids
Asmanex Aerobid
Azmacort QVar
Flovent Pulmicort |
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Term
| combiation of B2 and steroids |
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Definition
Advair = steroid + salmeterol
Symbicort= steroid + formoterol
Dulera = steroid + formoterol |
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Term
| what are some proven environmental controls? main points |
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Definition
house dust mites
cats and dogs
cockroaches and molds |
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Term
| give one immunodulation to protect against asthma |
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Definition
Allergy shots have been shown to:
reduce the likelihood of developing asthma |
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Term
| Allergic Rhinitis vs Sinusitis: how to diagnose |
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Definition
basics: Do lab for allergies and CT for Sinus ( I think read below)
Lab tests- skin testing, RAST blood teste, CBC differential (elevated eosinophil count)
Sinus films: a 3-view sinus series (Caldwell, Waters, and lateral views) helpful in evaluating for sinusitis of the maxillary, frontal, and sphenoid sinuses. The ethmoid sinuses are difficult to visualize clearly on x-ray films. Plain x-ray films can be helpful for diagnosing acute sinusitis. (RARELY USED)
CT scanning of the sinuses is more sensitive and specific.
plain x-ray films are often inconclusive
CT scan is much preferred. |
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Term
Know this definition (know all the location of diff sinuses and related pain)
Sinusitis- inflammation of the paranasal sinuses, which may or may not be as a result of infection, from bacterial, fungal, viral, allergic or ________ issues. |
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Definition
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Term
Know this definition
Rhinosinusitis, taking into account the thought that inflammation of the sinuses cannot occur without some inflammation of the nose (rhinitis). |
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Definition
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Term
| common of bugs acute sinusitis |
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Definition
| Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Staphylococcus aureus. |
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Term
| 28 cards for lec 2 done ... i am gona take bathroom break now ... |
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Definition
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Term
| When does asthma become irreversible? |
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Definition
| Irreversible: with recurrent attacks & fibrosis |
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Term
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Definition
| Episodic: cough, dyspnea, wheezing lead to airway obstruction |
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Term
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Definition
| Reversible: (Early Phase only) If the bronchoconstriction, edema, and mucous production can be controlled |
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Term
Nonspecific hyper-irritability of tracheobronchial tree--anything could do it.
but give three Current working hypothesis: |
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Definition
airway inflammation: (may be influenced by allergens,medications, environmental factors, chemicals, infection, exercise, and emotional factors)
epithelial injury:( from mediator release & cellular infiltration which affect the neural endings)
glandular hypertrophy:(edema formation) |
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Term
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Definition
over distension of lungs
mucosal edema and cellular infiltrates in bronchial wall
denudation of surface epithelium
basement membrane thickening
thick, tenacious mucus plugs
hypertrophy of bronchial smooth muscle
hyperplasia of mucosal and submucosal vessels |
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Term
| in asthma there Interaction between inflammatory cells and the released mediators: name some mediators |
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Definition
histamines, leukotrienes, prostaglandins, platelet activating factors, bradykinins
Immediate inflammatory reaction
bronchoconstriction
vascular congestion
edema formation
Increased mucous production
F**k there is more ..read it from lec 3 slide 12 |
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Term
| Asthma activated by the interaction of antigen with mast cell-bound ____________. |
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Definition
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Term
| triads of asthma (I think?) |
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Definition
pharmacologic stimuli could be dye, BBm Aspirin
Aspirin allergy triad: (1% of adults); rhinitis leading to rhinosinusitis with nasal polyps developing Asthma |
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Term
respiratory viruses more common than bacterial for acute asthma- name some
viruses
Asthma could also be trigger by two other factors ..guess what are they |
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Definition
RSV, Rhinovirus and Influenza
Exercise, thermal change: heat movement from airway wall, thus the airway temp falls
emotional stress:Hyperemia & microvascular engorgement of bronchial circulation activity |
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Term
| 5 different kind of Asthma ... |
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Definition
Allergic
idiosyncratic
exercise
industrial
occupational asthma
Know each one in detail form power point ...lot of purple...(she is not really helping us..) |
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Term
| you got the types now classify Asthma |
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Definition
Intermittent
mild Persistent
moderate Persistent
severe Persistent Asthma |
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Term
| Define intermittent asthma. |
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Definition
Intermittent symptoms occurring less than once a week
Brief exacerbations
Nocturnal symptoms occurring less than twice a month
Asymptomatic with normal lung function between exacerbations
No daily medication needed
FEV1 or PEF rate greater than 80%, with less than 20% variability |
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Term
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Definition
Symptoms occurring more than once a week but less than once a day
Exacerbations affect activity and sleep
Nocturnal symptoms occurring more than twice a month
FEV1 or PEF rate greater than 80% predicted, with variability of 20-30% |
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Term
| moderate persistent asthma --Define |
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Definition
Daily symptoms
Exacerbations affect activity and sleep
Nocturnal symptoms occurring more than once a week
FEV1 or PEF rate 60-80% of predicted, with variability greater than 30% |
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Term
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Definition
Continuous symptoms
Frequent exacerbations
Frequent nocturnal asthma symptoms
Physical activities limited by asthma symptoms
FEV1 or PEF rate less than 60%, with variability greater than 30% |
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Term
| A reduced ratio of FEV1 to FVC, when compared with predicted values, demonstrates the presence of ________ airway. |
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Definition
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Term
PFT for Asthma-- how do you do it?
what percentage difference should be seen to dx asthma? |
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Definition
do initial PFT.
give Albuterol 2.5mg SVN
do spirometry again.
compare the before and after.
Reversibility is demonstrated by an increase of 12% and 200 mL after the administration of a short-acting bronchodilator |
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Term
Board question.
How are pulmonary functions numbers affected with Asthma? U better know it |
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Definition
FEV1: reduction
FVC( forced vital capacity): decreased
RV (residual volume): increased
FRC (functional residual capacity): doubles
TLC: increases |
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Term
| asthma tx is based on what? |
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Definition
Classification.
remember intermittent, mild, moderate, severe |
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Term
| Treatment for Intermittent asthma |
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Definition
Education:
Avoidance of triggers
Antihistamine oral
Disease & process
Signs if worsening
main------>> B-agonist for rescue (albuteral inhaler |
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Term
| Treatment: Mild Persistent Asthma |
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Definition
inhaled corticosteroids--- most potent and effective long term.
Leukotriene esteraste inhibitors: montelukast, zafirlukast
Combination inhaled corticosteroids with long acting B-agonist |
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Term
| Treatment: Mild Persistent Asthma |
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Definition
inhaled corticosteroids--- most potent and effective long term.
Leukotriene esteraste inhibitors: montelukast, zafirlukast
Combination inhaled corticosteroids with long acting B-agonist |
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Term
| Treatment for Moderate Persistent Asthma |
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Definition
Inhaled corticosteroids- most potent
& effective long term control therapy.
Sympathomimetics Beta-agonists: short acting for prompt relief; long acting for prevention (Serevent, Foradil).
Combination inhaled corticosteroids with long acting B-agonist (Advair, Symbicort)
Leukotriene esteraste inhibitors: oral montelukast, zafirlukast |
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Term
| drug therapy for severe asthma |
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Definition
all the one that should be given to mild and moderate
+
Monoclonal antibodies
5-Lipoxygenase inhibitors |
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Term
| know how does Atrovent work? |
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Definition
| blocks the muscarinic pathway. decreases vagal tone. similar to atropine. |
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