Objectives for Asthma and COPD by m1Z60682


									Course Objectives
Pulmonary Diseases - Asthma and COPD

By the end of the unit the student will be able to:
   1. Define the term asthma
       Asthma is a chronic inflammatory disorder of the airways in which many cells
       and cellular elements play a role, in particular, mast cells, eosinophils and
       epithelial cells. In susceptible individuals, this inflammation causes recurrent
       episodes of wheezing, breathlessness, chest tightness and coughing, particularly
       at night or in the early morning. These episodes are usually associated with
       widespread but variable airflow obstruction that is often reversible either
       spontaneously or with treatment. (Slightly shortened version)

   2. List some of the agents or triggers that may precipitate bronchospasm.
      Exercise, viral infection, Animals with fur or feathers, house-dust mites, Mold,
      Smoke, Pollen, Changes in weather, Strong emotional expressions, Airborne
      chemicals or dusts, Menses, Aspirin use

   3. Summarize the signs and symptoms of asthma. Include clinical tests.
      Inability to speak with tachypnea
      Increased accessory muscle use
      Retractions – intercostal, supra & sub-sternal
      Prolonged exhalation
      Polyphonic wheezing
      Clinical test are mainly Peak Flows, complete pulmonary function test and the
      methocholine challenge test. The results of the tests usually show a decrease in
      peak flows that improve with bronchodilators. PFTs show an obstructive pattern
      with decreased FEV1. The methocholine challenge is performed in a pulmonary
      function lab and the patient is asked to inhale a nebulized treatment of a drug that
      will cause bronchospasm. An asthmatic will test positive with decreased peak
      flows and other symptoms of asthma. Other people will have no response or
      adverse effects to the methocholine.

   4. State the auscultary sounds with asthma.
      Asthmatics wheeze. Breath sounds are often decreased and show no wheezing
      before treatment and have a remarkable increase in breath sounds and polyphonic
      wheezing in all fields. “Dire” Signs in Asthma auscultation is an absence of
      wheezing while patient continues to be in distress. Then the patient has an
      ominous decreased level of consciousness that the therapist should recognize as
      life-threatening. Also evidence of abdominal paradox indicates fatigue of the
      diaphragm and is a sign the patient’s condition is worsening.

   5. Summarize pulmonary function test results with an asthmatic patient.
       PFTs show an obstructive pattern with decreased FEV1. Decreased FVC.
       Decreased FEV1/FVC and an increased RV

   6. Summarize the pharmacology in the treatment of asthma.
        a. Adrenergic drugs
                i. Prevention of exercise-induced bronchospasm
               ii. Relief of acute symptoms
        b. Anticholinergic drugs
                i. May decrease mucus gland secretion
               ii. Short term relief of bronchospasm
        c. Aerosolized steroids
                i. Long term inflammation control
               ii. Fewer systemic effects with lower doses
        d. IV steroids
                i. Used as short term bolus for exacerbation control
        e. Oral steroids
                i. For long term control of severe persistent asthma
        f. Cromolyn
                i. For non-steroid long term control of mild to moderate asthma
        g. Leukotriene modifiers
                i. For non-steroid long term control of mild to moderate asthma

   7. State the usual method of evaluating the effectiveness of bronchodilators with
      Assess patient’s work of breathing. Assess peak flows. Education plan, Proper use
      of spacer and peak flow meter

  1. Define:
        a. Chronic bronchitis
                i. A condition which causes a productive cough for a period of 3
                   successive months for 2 consecutive years
        b. Acute bronchitis
                i. A shorter course of cough and sputum production
        c. Emphysema
                i. An obstructive disease of the lung characterized by loss of lung
                   tissue and dilation of lung units distal to the terminal bronchiole
        d. Bronchiectasis
                i. Dilation of bronchioles due to weakness of bronchiolar walls
        e. COPD
                i. A catch-all diagnosis that the patient may have symptoms of
                   emphysema and chronic bronchitis. Also may involve elements of
                   asthma and bronchiectasis
  2. List the pathological features of bronchitis.
        a. Increase in the size of mucus glands
        b. Increase in the number of goblet cells
        c. Inflammation of the bronchial walls
        d. Mucus plugging in peripheral airways
        e. Loss of cilia
        f. Narrowing airways, leading to airflow obstruction
3.   List the clinical signs and symptoms of chronic bronchitis.
        a. Cough with sputum production
        b. Dyspnea on exertion, progressingly worsening
        c. CO2 retention and hypoxemia in advanced stages
        d. Increased hemoglobin and hematocrit
        e. Right-sided heart failure (cor pulmonale) in advanced stages
4.   Describe the diagnostic tests for bronchiectasis.
        a. Chest X-ray shows airway dilatation
        b. CT scan is new definitive test showing cystic spaces and dilated walls
5.   List the clinical features of bronchiectasis
        a. A productive cough with large amounts of thick purulent secretions, which
            may be foul smelling. Often, a layering of the sputum occurs. Bronchial
            obstruction may render the mucociliary transport system ineffective
            leading to an accumulation of thick secretions and many chronic
            respiratory infections
6.   List and briefly describe the common complications of COPD and
        a. Dyspnea – reduced breath sounds - cyanosis
        b. Increased accessory muscle use – barrel chest – hyper-inflated lungs
        c. CO2 retention
        d. Digital clubbing (with help from other chronic diseases)
7.   Discuss the treatment modalities for COPD:
        a. Bronchodilators
                  i. Reverses bronchospasm and improves airway flow
        b. Aerosol therapy
                  i. Aids in hydration and thinning of secretions
        c. Oxygen therapy
                  i. Prevent hypoxemia and extend quality of life
        d. Corticosteroids
                  i. Long term maintenance of airway inflammation
        e. Breathing Exercises
                  i. Abdominal breathing – using of diaphragm to aid in overuse
                     accessory muscle use
                 ii. Pursed lip breathing – prevents premature airway closure by
                     producing a back pressure into the airways on exhalation.
                         1. Decreased the incidence of air trapping
                         2. Slows the expiratory flows
                         3. Improves the removal of secretions by keeping airways

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