Pulmonology Lect 3- Asthma

Maintenance, control, and preventive medications are designed to reduce and control airway inflammation in individuals with respiratory conditions such as asthma. These medications work by reducing the inflammation in the airways, which helps to alleviate symptoms and prevent asthma attacks. By attenuating airway inflammation, these medications can help to improve breathing and overall respiratory function. Therefore, the statement that maintenance, control, and preventive medications act to attenuate airway inflammation is true.

There is evidence to support the existence of a genetic predisposition to asthma. Research has shown that individuals with a family history of asthma are more likely to develop the condition themselves. Studies have identified specific genes that are associated with an increased risk of asthma, suggesting a genetic component to the disease. Additionally, twin studies have demonstrated a higher concordance rate for asthma in identical twins compared to fraternal twins, further supporting the role of genetics in asthma susceptibility.

Systemic corticosteroids can cause a variety of side effects, including osteoporosis (weakening of the bones), cataracts (clouding of the lens in the eye), redistribution of fat (leading to a rounded face and increased fat in the abdomen), edema (fluid retention), thinning of the skin, increased blood glucose levels in diabetics, decreased immune function, and stunted growth in children. These side effects are well-documented and known to be associated with the use of systemic corticosteroids.

Albuterol is indeed the most common short-acting inhaled beta-adrenergic agonist. It is widely used to treat and relieve symptoms of asthma and other respiratory conditions. Albuterol works by relaxing the muscles in the airways, allowing them to open up and making breathing easier. It is available in various forms, including inhalers and nebulizers, and is considered a first-line treatment option for acute asthma attacks. Due to its effectiveness, widespread availability, and long-standing use, albuterol has become the most commonly prescribed short-acting inhaled beta-adrenergic agonist.

The statement is true because the normal peak flow refers to the highest flow rate of air that a person can achieve when their airways are completely open and functioning optimally. This is considered the "best" peak flow for the patient because it indicates that their lungs are functioning at their highest capacity.

Theophylline needs to be monitored closely due to its narrow toxic-to-therapeutic range, which means that the difference between a safe and toxic dose is small. Additionally, individuals metabolize the drug differently, so monitoring is necessary to ensure that the drug is being processed effectively. Furthermore, the absorption and metabolism of the drug can be influenced by various factors, making close monitoring necessary to maintain therapeutic levels and avoid toxicity. Therefore, the statement is true.

The green zone in the peak flow system implies good control, with a peak expiratory flow (PEF) of 80%. This means that the patient has no asthma symptoms and should continue taking their medications as usual.

Corticosteroids, long-acting bronchodilators, and leukotriene antagonists are classified as long-term control medications for asthma. These medications are used to manage and control asthma symptoms over an extended period of time. They work by reducing inflammation, opening up the airways, and preventing the release of substances that cause inflammation and constriction of the airways. Long-term control medications are typically taken on a regular basis to maintain asthma control and prevent asthma attacks.

Short-acting beta-adrenergic agonists should be used in all patients to treat acute symptoms. This is because these medications work quickly to relax the muscles in the airways, providing immediate relief for symptoms such as wheezing and shortness of breath. They are commonly used in the treatment of asthma and other respiratory conditions. However, it is important to note that while short-acting beta-adrenergic agonists are effective for acute symptom relief, they are not a long-term solution and should be used in conjunction with other medications as prescribed by a healthcare professional.

Spirometry is a pulmonary function test that measures the amount of air a person can inhale and exhale, as well as the speed at which they can exhale. It is an essential tool in the evaluation of asthma as it helps to assess lung function and diagnose the condition. Performing spirometry before and after the administration of a short-acting bronchodilator helps to determine the reversibility of airflow obstruction, which is a characteristic feature of asthma. This test can help confirm the diagnosis, assess the severity of the condition, and monitor the effectiveness of treatment. Therefore, the statement that the evaluation for asthma should include spirometry before and after the administration of a short-acting bronchodilator is true.

The correct answer is that normal peak flow is what the patient's peak flow is when he/she is at their best. This means that the normal peak flow is the highest level of airflow that the patient is able to achieve. It serves as a baseline for comparison and helps in monitoring the patient's respiratory health.

Cor pulmonale is defined as hypertrophy of the right ventricles resulting from disease of the lungs. This condition occurs when the lungs are unable to efficiently oxygenate the blood, leading to increased pressure in the pulmonary arteries and subsequent enlargement of the right ventricle. Common causes of cor pulmonale include chronic obstructive pulmonary disease (COPD), pulmonary hypertension, and lung disorders such as emphysema or pulmonary fibrosis. The increased workload on the right ventricle can eventually lead to heart failure if left untreated.

Atopy refers to a genetic tendency to develop allergic diseases such as asthma, eczema, and hay fever. Individuals with atopy have a heightened immune response to common allergens, leading to allergic reactions. This genetic predisposition can be inherited and increases the likelihood of developing allergies when exposed to allergens. Therefore, the statement that atopy is the genetic predisposition to respond to allergens is true.

Asthma medications can be categorized into two types: long-term control medications and quick-relief (rescue) medications. Long-term control medications are taken daily to achieve and maintain control of persistent asthma. They help in preventing asthma symptoms and reducing inflammation in the airways. On the other hand, quick-relief (rescue) medications are taken to provide immediate relief by relaxing the bronchial smooth muscles and reversing acute airflow obstruction. These medications are used during asthma attacks or when symptoms suddenly worsen.

The correct answer is "Asthma action plan with green-go, yellow-caution, red-stop zones." This answer suggests that the written action to provide to patients should be an asthma action plan that includes different zones based on the signs and symptoms of expiratory flow rates. The green zone indicates that the patient's asthma is under control and they can continue with their regular medication. The yellow zone indicates caution and advises the patient to take additional medication or seek medical advice. The red zone indicates a medical emergency and advises the patient to stop their regular medication and seek immediate medical attention.

The red zone in the peak flow system indicates a medical alert, which means that the patient's peak expiratory flow (PEF) is less than 50%. In this zone, the patient should use a short-acting inhaled beta-agonist and seek immediate medical attention by calling the provider or going to the emergency room. This suggests that the patient's asthma is poorly controlled and requires immediate intervention to prevent worsening symptoms or complications.

Long-acting beta-adrenergic agents are used to prevent exercise-induced bronchospasm and treat nocturnal symptoms. However, they should not be used as a replacement for anti-inflammatory therapy. Anti-inflammatory medications are necessary to treat the underlying inflammation in the airways, while long-acting bronchodilators help to relax and open the airways. Using bronchodilators alone without anti-inflammatory therapy may provide temporary relief of symptoms but does not address the underlying inflammation. Therefore, it is important to use both types of medication for effective management of exercise-induced bronchospasm and nocturnal symptoms.

The correct answer is "caution, 50-80%". In the peak flow system, the yellow zone represents cautionary control, indicating that the patient's peak expiratory flow (PEF) is between 50-80% of their personal best. When the PEF falls within this range, it suggests that the patient's asthma is not well controlled and they may be at risk for worsening symptoms. In this situation, the patient should use a short-acting inhaled beta-agonist to relieve their symptoms and consult with their healthcare provider for further management.

Short-acting inhaled beta-adrenergic agonists, such as albuterol, are the most effective bronchodilators during asthma exacerbations. These medications work by relaxing and opening up the airways, allowing for easier breathing. They provide quick relief of symptoms and are commonly used as rescue medications during asthma attacks. Leukotrienes, corticosteroids, and anticholinergic agents may also be used in the treatment of asthma, but they are not as effective in providing immediate bronchodilation during exacerbations.

Based on the symptoms described, such as episodic wheezing, difficulty breathing, chest tightness, and cough, the likely diagnosis is asthma. These symptoms are characteristic of asthma, which is a chronic inflammatory disease of the airways. In some cases, the airflow may be too limited to produce wheezing, and auscultation may reveal globally reduced breath sounds with prolonged expiration. COPD, bronchiectasis, and cystic fibrosis can also present with similar symptoms, but asthma is the most likely diagnosis based on the given information.

Leukotriene antagonists are indeed considered alternatives to low-dose inhaled corticosteroids in patients with mild persistent asthma. Leukotriene antagonists work by blocking the action of leukotrienes, which are inflammatory substances that contribute to asthma symptoms. They are effective in reducing symptoms and improving lung function in patients with mild persistent asthma. In some cases, they may be preferred over inhaled corticosteroids due to their oral administration and convenience. However, the choice between leukotriene antagonists and inhaled corticosteroids should be based on individual patient characteristics and preferences.

Status asthmaticus is the correct answer because it accurately describes a prolonged, severe asthma attack that does not respond to treatment and involves severe bronchospasm. This condition is so severe that it puts the patient at risk for respiratory failure.

Ipratropium bromide (Atrovent) is the most common anticholinergic agent used for quick relief for asthma exacerbations. Anticholinergic agents work by blocking the action of acetylcholine, a neurotransmitter that causes bronchoconstriction. By blocking this action, ipratropium bromide helps to relax and open up the airways, providing relief for asthma symptoms. Levalbuterol (Xopenex) and salmeterol (Serevent) are both bronchodilators but do not have anticholinergic properties. Prednisone is a corticosteroid that is used for long-term control of asthma, not for quick relief.

Systemic corticosteroids are indeed used for prompt control of asthma during exacerbations and also when initiating long-term asthma therapy. These medications are effective in reducing inflammation and suppressing the immune response in the airways, which helps to relieve symptoms and improve lung function. They are typically prescribed for short periods during asthma exacerbations to quickly bring the condition under control, and in some cases, they may also be used as long-term therapy to manage chronic asthma. Therefore, the statement is correct.

The treatment for persistent asthma involves daily anti-inflammatory therapy with inhaled corticosteroids. This is because persistent asthma is characterized by ongoing inflammation in the airways, and inhaled corticosteroids help reduce this inflammation and prevent asthma symptoms. Short-acting bronchoconstrictors and short-acting bronchodilators provide relief during acute asthma attacks but do not address the underlying inflammation. Long-acting bronchodilators may be used in combination with inhaled corticosteroids for more severe cases, but daily anti-inflammatory therapy with inhaled corticosteroids is the mainstay of treatment for persistent asthma.

Levalbuterol is the R isomer of albuterol. It is given in lower doses compared to albuterol and has fewer adverse effects associated with beta-agonists such as tremors, hyperactivity, and tachycardia. Therefore, Levalbuterol is a preferred medication when the goal is to minimize these side effects while still providing bronchodilation. Ipratropium bromide is a different medication that is not an isomer of albuterol and works by a different mechanism of action.

Corticosteroids are the most potent and consistently effective anti-inflammatory agents currently available. They work by suppressing the immune system and reducing inflammation in the body. This makes them highly effective in treating a wide range of inflammatory conditions such as asthma, allergies, arthritis, and skin disorders. Corticosteroids are available in various forms including oral tablets, inhalers, creams, and injections, allowing for targeted treatment depending on the specific condition. Their effectiveness and versatility make them the preferred choice for managing inflammation in medical practice.

Systemic corticosteroids have the potential to cause long-term suppression of the hypothalamic-pituitary-adrenal (HPA) axis after administration for 2 weeks or more. This is because corticosteroids mimic the effects of cortisol, a hormone produced by the adrenal glands. Prolonged use of corticosteroids can inhibit the production of cortisol by the adrenal glands, leading to HPA axis suppression. This can result in adrenal insufficiency and other hormonal imbalances. Anticholinergic agents, beta-adrenergic agents, and phosphodiesterase inhibitors do not have this effect on the HPA axis.

The patient's presentation with copious, foul-smelling, purulent sputum, persistent crackles at the lung bases, digital clubbing, weight loss, anemia, leukocytosis with a left shift suggests a possible respiratory infection. Ordering a culture and sensitivity test on the sputum sample would help identify the specific pathogen causing the infection and determine its sensitivity to different antibiotics. Gram stain would provide information about the morphology and arrangement of bacteria present in the sputum, aiding in the initial identification of the pathogen. Additionally, testing for acid-fast bacteria would be important to rule out tuberculosis, as it is known to cause similar symptoms.

Inhaled corticosteroids are first-line agents for patients with persistent asthma because they help reduce airway inflammation and prevent asthma symptoms. Mediator inhibitors, on the other hand, are agents used for patients with mild persistent asthma or exercise-induced asthma. They work by blocking the release of inflammatory mediators, such as histamine, that contribute to asthma symptoms.

Beta-Adrenergic agents should not be used during acute bronchoconstriction because they have a delayed onset of action. However, they are good for long-term control because they provide bronchodilation for up to 12 hours. This means that while they may not provide immediate relief during an acute episode, they can be effective in managing and preventing bronchoconstriction over a longer period of time. Therefore, the statement is true.

Leukotrienes are biochemical mediators that contribute to airway obstruction and asthma symptoms by contracting airway smooth muscle, increasing vascular permeability and mucus secretion, and attracting and activating airway inflammatory cells. Leukotriene antagonists are medications that block the effects of leukotrienes, helping to reduce airway constriction and inflammation in asthma patients.

The correct answer is 0-4, 5-11, 12 and older. This age group classification is based on the treatment recommendations provided by the EPR-3. It suggests that treatment recommendations for respiratory conditions should be tailored differently for children between the ages of 0-4, 5-11, and 12 and older. This age-based approach takes into consideration the developmental and physiological differences among these age groups, ensuring appropriate and effective treatment strategies for respiratory diseases.

The three components that characterize asthma are inflammation of the airways, obstruction to airflow, and bronchial hyper-reactivity. Inflammation of the airways refers to the swelling and irritation of the bronchial tubes, which can lead to symptoms such as coughing and wheezing. Obstruction to airflow occurs when the airways become narrow or blocked, making it difficult for air to move in and out of the lungs. Bronchial hyper-reactivity refers to the increased sensitivity of the airways to various triggers, causing them to constrict and further obstruct airflow.

Long term asthma control medications are taken to reduce inflammation, airflow obstruction, and bronchospasm. These medications work over a longer period of time to reduce the underlying inflammation in the airways, which helps to prevent the occurrence of symptoms such as airflow obstruction and bronchospasm. On the other hand, quick relief medications are taken to directly reduce symptoms such as airflow obstruction, inflammation, and bronchospasm when they occur.

Medication that acts to modulate mast cell mediator release and eosinophil recruitment is referred to as mediator inhibitors. Cromolyn sodium (intal) and nedocromil (Tilade) are examples of mediator inhibitors. These medications take weeks to show any beneficial effects, indicating that they have a slow onset of action.

Atrovent, an anticholinergic agent, can be prescribed for a patient who has an intolerance to beta agonists. Anticholinergic agents work by blocking the action of acetylcholine, a neurotransmitter that causes bronchoconstriction. By blocking this action, Atrovent helps to relax and open up the airways, providing relief for patients with respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD). This alternative medication can be an effective option for patients who cannot tolerate beta agonists due to side effects or other contraindications.

After using inhaled corticosteroids, it is important to advise the patient to rinse their mouth out to prevent local side effects such as cough, dysphonia (hoarse voice), and oropharyngeal candidiasis (thrush). Inhaled corticosteroids can cause irritation and fungal infections in the mouth and throat. Additionally, rinsing the mouth helps to reduce systemic absorption of the medication, minimizing the risk of systemic side effects.

Asthmatics may experience irritability due to hypoxia or hypercapnia. Hypoxia refers to a lack of oxygen in the body, which can occur during an asthma attack when the airways are constricted, making it difficult to breathe. Hypercapnia, on the other hand, is an excessive level of carbon dioxide in the bloodstream, which can also result from inadequate breathing during an asthma episode. Both conditions can lead to physiological changes in the body, such as increased heart rate and blood pressure, which can contribute to irritability.

Inhaled corticosteroids are preferred for long-term control of asthma and are considered first-line agents for patients with persistent asthma. They are effective in reducing airway inflammation and preventing asthma symptoms. Systemic corticosteroids are typically used for short-term treatment of acute asthma exacerbations. Long-acting bronchodilators and leukotriene antagonists may be used as adjunctive therapy, but inhaled corticosteroids are the mainstay of long-term asthma management.

The correct answer is amoxicillin/ amoxicillin-clavulanate and trimethoprim-sulfamethoxazole. Empirical oral antibiotic therapy is used when a specific bacterial pathogen cannot be isolated. Amoxicillin/ amoxicillin-clavulanate is a broad-spectrum antibiotic that covers a wide range of bacteria, while trimethoprim-sulfamethoxazole is effective against many common bacterial pathogens. Using both antibiotics together increases the likelihood of covering the potential pathogens causing the acute exacerbation.

remember- hyperinflation and peri-bronchial cuffing are signs of asthma on chest x ray

The three classifications of severity of asthma are intermittent, mild persistent, moderate persistent, and severe persistent. These classifications are based on the frequency and severity of asthma symptoms, as well as the level of lung function impairment. Intermittent asthma is characterized by symptoms occurring less than twice a week, while mild persistent asthma involves symptoms more than twice a week but not daily. Moderate persistent asthma includes symptoms occurring daily, and severe persistent asthma is characterized by continuous symptoms that limit physical activity.

Based on the symptoms described, the most likely diagnosis would be bronchiectasis. Bronchiectasis is a condition characterized by the permanent dilation of the bronchi and bronchioles, leading to a chronic cough, excessive production of purulent sputum, hemoptysis (coughing up blood), pleuritic pain (chest pain that worsens with deep breaths), and recurrent pneumonia. These symptoms are consistent with the clinical presentation of bronchiectasis, making it the most appropriate diagnosis among the options provided.

Beta-adrenergic agents should be used for the prevention of exercise-induced bronchospasm and for nocturnal symptoms. These medications work by relaxing the smooth muscles in the airways, thus helping to prevent bronchospasm and improve airflow. They are commonly used as long-term control medications for asthma and are effective in managing symptoms during exercise and at night.

Anticholinergic agents are a type of quick relief asthma medication that reverses vagally mediated bronchospasm. Vagally mediated bronchospasm is caused by the activation of the vagus nerve, which leads to the constriction of the airways. Anticholinergic agents work by blocking the action of acetylcholine, a neurotransmitter that stimulates the vagus nerve. This helps to relax and open up the airways, providing relief from bronchospasm. However, anticholinergic agents do not have the same effect on allergen or exercise-induced bronchospasms, which are caused by different mechanisms.

An arterial blood gas (ABG) is ordered to assess the oxygen and carbon dioxide levels in the blood, as well as the acid-base balance. In this case, mental status changes can indicate inadequate oxygenation to the brain, which may require an ABG to determine the severity. Signs of severe asthma suggest respiratory distress, which can be evaluated through an ABG. Lack of improvement after 30 to 60 minutes of aggressive therapy indicates a need to reassess the patient's condition, including their blood gas levels. Therefore, all three indications mentioned in the answer are valid reasons for ordering an ABG.

Bronchiectasis is a disorder of the bronchi characterized by permanent, abnormal dilation and destruction of the bronchial walls. It is a chronic and irreversible condition that can be congenital or acquired. The dilation of the bronchi is often caused by recurrent inflammation or infection of the airways. This condition is different from asthma, COPD, and cystic fibrosis, which have their own distinct characteristics and causes.

The three goals of treating asthma exacerbations are to reduce the likelihood of recurrence of obstruction, correct hypoxemia, and reverse airflow obstruction. These goals aim to improve the patient's breathing and prevent future episodes of asthma exacerbation. Correction of hypocalcemia is not mentioned as one of the goals of treating asthma exacerbations in the given options. Supplemental oxygen to maintain SaO2 greater than 89% is not listed as one of the goals, but it is a treatment approach to correct hypoxemia.

Foul smelling sputum is often due to an anaerobic infection. Anaerobic bacteria are known to thrive in environments with little to no oxygen, such as the lungs. These bacteria produce volatile sulfur compounds, which give the sputum its foul odor. Other types of infections, such as aerobic, viral, enteric, or mycobacterial, are less likely to cause foul smelling sputum.