Asthma
diffuse airway inflammation, narrowing in response to various stimuli..ENTIRELY OR PARTIALLY REVERSIBLE
status asthmaticus
asthma attack that does not respond to conventional tx
occupational asthma
bronchospasm, in response to provoking agent in the work place
stable asthma
4 weeks, no increase in symptoms or need for an increase in meds
unstable asthma
pt experiences increasing symptoms
Most common trigger of asthma attack
infections
triggers of asthma
Allergy(Mold, dander), Irritants(smoke, perfume pollution, chlorine), Resp. infection, cold air, reflux and medications
lack of uniform ventilation caused by??
combination of bronchospasm, mucus plugging, and mucosal edema>>>INCREASED AIRWAY RESISTANCE
V/Q
the result of vascular resistance...V/Q mismatch results in hypoxemial
pulmonary vascular resistance increases as a result of
hypoxemia
initially ariway obstruction primarily effects??
exhalation..results in air trapping and progressive hyperinflation of the lungs
increases the work of breathing??
combination of increased airway resistance and lung hyperinflation
acute asthma attack complaints??
chest tightness, dyspnea, wheezing and coughing
confirm the dx from
pt's age, medical hx, physical findings, xray, lab tests
Common findings with asthma
tachypnea, use of accessory muscles of breathing, prolonged exhalation, increased A/P diameter, expiratory polyphonic wheezing, diaphoresis and intercostal retractions.
Severe asthma suggested by??
pronounced use of accessory muscles, abnormal sensorioum paradoxical pulse, tachypnea, inablilty to speak and wheezing on inhalation and exhalation
Signs of fatique
decreaseing peak flow, diaphoresis and abdominal paradox(inward movement of ab walls during inpiration from fatigue of diaphragm.
peak flow suggesting severe obstruction
less than 100 liters/minute or an FEV1 of less than 1.0 L in an adult
Methacholine provocation
used to provoke bronchspasm...for testing..Asthmatics will have greater than 20%decrease in FEV1 in response to methacholine, normal pt.s have little or no response
Mild asthma
Normal PO2, decrease CO2, increase in pH..Increased Respiratory rate, blowing off CO2(acid) increasing pH towards alkaline
Severe asthma(status asmaticus)
decrease in PO2, normal or increasd CO2(retaining, because narrowing of airway, can't get CO2 out), making pH normal or decreased, towards 0 (ACID)
Immunoglobulin E (IgE)
plays role in pathogenesis of allergic diseases, such as asthma
Anatomical alterations
smooth muscles, small airways constrict, increases 3X's it's normal size, airways filled with mucus, plugging
CC of asthma
chest tightness, difficult breathing, wheezing, coughing
Can be seen in a physical exam
tachypnea, accessory muscle use, PROLONGED exhalation, Increased AP Diamater, Expiratory polyphonic wheezing, diaphoresis, intercostal retractions
Status asthmaticus physical exam
pronounced use of accessory muscles, paradoxial pule, inability to speak, I and E wheezing, decreased peak flows, diaphoresis, abdominal parox and abnormal sensorium
CHEST XRAY
Often normal, but can see hyperinflation...and Pneumonia, Atelectasis, and Pneumothorax
refractory
whatever tx you do, conventional, it doesn't work
Treatment
educate pt, determine severity, use a bronchodialator and control meds
sputum with asthma
white, tenancious(sticky), thick
Peak Flow readings
Green zone 80% or higher..Yellow zone 50-80%, Red zone less than 50%..based on pt's age, height, and sex
PEFR
peak expiratoyr flow rate
Extrinsic asthma
allergic asthma, excessive IgE in body, mast cell degranulation..causes constriction..exploding release of histamines
Meds for extrinsic astma
Xolair and singulair
IgE
natural, found in body, excessive in pt's with allergic asthma
Omalizumab(Xolair)
anti IgE medication
Leukotriene
released from mast cells, eosinophils and basophils, lead to increased inflammation
Leukotriene modifier
singulair.,.usually added with a bronchodialator
Nocturnal asthma
12pm-4Am, GERD(micro aspiration of stomach contents, reflux), Allergin exposure(dust mites), temp change in body, delayed exposure to allergins from the day, low cirulation of adrenal gland hormones
occupational asthma
animal substances, chemicals enxymes, metals plant substances, resp. irritants
intermittent
<2 x's week, normal PEFR between..No meds
mild persistent
>2x's week but , 1/day...inhaled antiinflammatory
moderate persistent
Daily symptoms, inhaled steroids and long acting bronchodialator
severe persistent
limited physical activity, frequent exacerbations, oral and Inhaled steroids +everything else
5 Classifications of Asthma
Extrinsic(allergic), Intrinsic(non-allergic), Exercise-induced, Nocturnal and Occupational
Immediate attack
usually resolves within 1 hr of exposure
Late attack
happens within hours of exposure, lasts longer
biphasic attack
combo of Immediate and Late attack
Intrinsic Asthma
nonspecific stimuli..rhinovirus and URI, are triggers.
nonspecific causes of intrinsic asthma
exercise in cold dry air, drugs, foods, relux, Stree, premenstral, smoke, heriditary, obesity
Exericse induced asthma
poor athletic performance, long recovery time after exercise, fatigue furing exercise, coughing, wheezing, chest tightness or pain, SOB,
Bronchospasm,<mucusplugging,mucosal edema
increased airway resistance leads to V/Q mismatching leads to hypoxemia leads to Increased pulmonary vascular resistance