ASTHMA

Name 2 OBSTRUCTIVE AIRWAY DISEASES

What is the purpose of the RESPIRATORY SYSTEM?

VENTILATION is the movement of air from where to where?

What is PERFUSION?

What is DIFFUSION

Does asthma have its onset in childhood/adolescence or adulthood?

List the manifestations of Asthma

Asthma can be characterized as EXTRINSIC or INTRINSIC. Define each and what causes them.

EARLY phase or ACUTE response to asthma, when does it occur?

in the ACUTE phase of asthma, direct stimulation of PARASYMPATHETIC receptors causes what?

when does LATE PHASE response occur and how long does it last?

Late Phase response involves what?

treatment for all asthma pt's is approached in what two ways?

Evaluation of asthma includes what 4 things?

Prevalence of Asthma - who is it highest in?

Is the prevalence of asthma increasing or decreasing? what about prevalence of asthma attacks? What about asthma mortality rates?

When is childhood asthma susceptibility determined in life?

List the 4 risk factors for developing childhood asthma

In the US is asthma higher in urban nor rural areas?

List the 2 main risk factors for adult onset asthma and the 3 main ones for women

the etiology of asthma is multi-modal and most often without one singular cause. True or false?

Asthma is characterized by...

What are the main mechanisms (natural process by which something takes place or is brought about) leading to the development and persistence of asthma?

Are the symptoms of asthma the same in all patients?

In asthma is the lower airway obstruction usually reversible?

What are the triggers for EXTRINSIC aka ATOPIC or ALLERGY ASTHMA

What are the triggers for INTRINSIC or NON- ATOPIC asthma

Do most individuals with asthma have extrinsic or intrinsic asthma?
What is the major pathologic feature of both types?

During the early phase response, Mast cell activation releasing ____ mediators increase MUCUS secretion, increase VASCULAR PERMEABILITY and BRONCHOCONSTRICTION

Late Phase Response: release of INFLAMMATORY mediators causes recruitment of INFLAMMATORY CELLS which cause what to happen?

List the INFLAMMATORY MEDIATORS/CELLS involved in the inflammatory process and in the pathogenesis (development of the disease) of asthma

HISTAMINES role in asthma

LEUKOTRINES role in asthma

Prostaglandin D2 role in asthma

CHEMOTACTIC CHEMOKINES role in asthma

CYTOKINES (TNF-alpha, IL-4, IL-5) role in asthma

PAF (platelet activating factor) role in asthma

T LYMPHOCYTES (T helper 2), do they play an important role in INTRINSIC or EXTRINSIC

Bronchospasm is

During a bronchospasm, is the parasympathetic (rest and digest) control of the airway functioning properly?

MUCUS HYPERSECRETION is a major pathophysiological feature of asthma. How does it work?

LEUKOTRIENES are known to stimulate what?
INTERLEUKIN-9 & 13 are the 2 most relevant cytokines that up-regulat what?

What is the most damaging effect of MUCUS HYPERSECRETION?

What is this the definition of?
increase in goblet cells, hyperplasia & hypertrophy of smooth muscle cells, leading to a thickened smooth muscle layer, inc airway deposition of collagen & other proteins resulting in thickening of the lamina reticular with sub epithelial fibrosis & inc vascularity in the airway wall.

AIRWAY REMODELLING : structural changes in the airway wall probably occur in parallel with ____

WRITE OUT IN COLOUR THE PUTTING IT ALL TOGETHER PAGE 14

explain the IMMEDIATE or EARLY PHASE

explain the LATE_PHASE

WRITE OUT CLINICAL MANIFESTATIONS ON PAGE 17

SYMPTOMS of asthma are subjective in nature and are reported by the patient. They may include

DYSPNEA

CHEST TIGHTNESS

COUGH

WHEEZING

If AIRWAY OBSTRUCTION PERSISTS what can happen?

What are some of the signs you may notice upon inspection of a person with asthma?

Upon AUSCULTATION what might you notice with a patient who has asthma?

Vital Signs of someone with Asthma

explain why someone with asthma may be TACHYCARDIC

What is the most helpful Lab Value in asthmatic patient?

Hyperventilation will INITIALLY cause respiratory ALKALOSIS which may be accompanied with hypoxemia or a low pO2 during an attack
BUT with persistent worsening the patient will progress to what?

how can the acid-imbalances and hypoxemia associated with asthma be addressed?

What does a high pH of 7.50 indicate?
What does a low pO2 of 76 indicate?

What does a low pH of 7.35 indicate?
What does a high pCO2 of 49 indicate?
What does low pO2 of 70 indicate?

what are the normal ABG values?
pH
pCO2
HCO3
pO2

What are the various tests commonly done as part of the work-up for a patient in respiratory distress?

Chest x-rays - what are the common radiological findings for an asthmatic patient experiencing an acute exacerbation of the disease.

which is the more common trigger of an exasperation of asthma, a viral or bacterial respiratory infection?
Are antibiotics warranted?

What is the most OBJECTIVE MEASUREMENT of LUNG FUNCTION?

List the 3 Pulmonary Function Tests

How is PEAK FLOW MONITORING used?

PEF > 80% of personal best indicates?

PEF 50-80% indicates?

PEF < 50% indicates?

Medication for asthma can be separated into 2 categories: LONG-TERM control and QUICK -RELIEF medications.
What do each address?

List 3 classes of Quick-Relief medications for asthma

how does a BETA 2 AGONIST (quick relief) work?

*can affect Beta 1 receptors in the heart, causing TACHYCARDIA

how does an ANTICHOLINERGIC (quick relief) work?

how does a SYSTEMIC CORTICOSTEROID (quick relief) work?

What are 3 classes of LONG-TERM CONTROL Medications?

How does a LONG-ACTING BETA 2 AGONIST work?

**** cAMP ***

how does a MAST CELL STABILIZER (long-term control) work?

how does the MONOCLONAL ANTIBODY subcutaneous injection (long-term control ) work?

which is the preferred quick relief medication?

What should be included in patient teaching for a pt with asthma?

Is the prevalence of asthma increasing in Canada and worldwide or decreasing?

Pharmacologic interventions are aimed at decreasing ____ and addressing ____