respiratory diseases pt 2.txt

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respiratory diseases pt 2.txt
2012-09-03 14:40:52
respiratory diseases pt

respiratory diseases pt 2
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  1. Allergic rhinitis (hay fever)
    • a collection of symptoms in the nose and eyes due to exposure to an allergen
    • allergen exposure causes release of numerous mediators such as histamine and leukotrienes
  2. Common allergens for allergic rhinitis (hay fever)
    • dust
    • dander
    • mold
    • pollen
    • mites
    • cockroaches
  3. Treatments for allergic rhinitis (hay fever)
    • Histamine 1 (H1) receptor antagonists
    • Glucocorticosteroids
    • alpha1-adrenergic receptor agonists (decongestants)
    • leukotriene receptor antatgonists
  4. Hay fever H1 receptor antagonists
    • blocks H1 receptors
    • oral or intranasal spray
    • treats: rhinorrhea, sneezing, nasal pruritis & nasal congestion
  5. Potential side effects of H1 receptor antagonists
    • sedation
    • dry mouth
  6. Glucocorticosteroids
    • inhibit release of mediators from inflammatory cells
    • intranasal spray
    • treats: sneezing, nasal pruritis, nasal discharge & nasal congestion
  7. Potential side effects of glucocorticosteroids
    tend to be minimal due to limited systemic exposure (nasal spray)
  8. alpha1-adrenergic receptor agonists (decongestants)
    • activate alpha1-adrenergic receptors causing vasoconstriction of blood vessels in nose, throar and sinuses
    • oral or intranasal spray (not to be used for more than 3 days)
    • treats: inflammation, nasal swelling & mucus production
  9. Potential side effects of alpha1-adrenergic receptor agonists (decongestants)
    increased systemic blood pressure, tremor, tachyphylaxis, nausea, vomiting, weakness & headache
  10. Leukotriene receptor antagonists
    • block leukotriene receptors
    • oral roue of administration
    • treats: nasal secretions, nasal congestion & vasodilation
  11. Potential side effects of leukotriene receptor antagonists
    vomiting, diarrhea & headache
  12. COPD
    • chronic inflammation of the lungs
    • lungs exhibit structural changes
    • compromised respiratory gas exchange
    • diseases include: asthma, chronic bronchitis, emphysema, pneumoconiosis
  13. RLD
    • characterized by reduced lung volume
    • increased lung stiffness (decreased lung compliance)
    • disease of lung parenchyma, pleura, chest wall or neuromuscular apparatus
    • diseases include: pulmonary fibrosis, lung cancer, pneumonia
  14. Asthma
    • inflammatory disorder of the airways
    • three types: allergic, exercise-induced and occupational
  15. Characteristics of asthma
    • wheezing
    • shortness of breath
    • chest tightness
    • coughing
  16. Three types of asthma
    • allergic - triggered by allergens
    • exercise-induced - worsens when breathing cold, dry air during exercise
    • occupational - caused or worsened by breathing in a workplace irritant such as chemical fumes, gases or dust
  17. Biological indicators of asthma
    • airway obstructors
    • airway inflammation
    • airway hyperresponsivemess
    • airway remodeling
  18. Allergic asthma immediate phase reaction
    • starts withing seconds, lasts ~1 hour
    • caused by release of preformed mediators such as histamine, prostaglandins, thromboxane A2
    • clinical response includes smooth muscle contraction, airway obstruction and increased microvascular permeability
  19. Allergic asthma late phase reaction
    • takes up to 6-12 hours to develop
    • caused by the induces synthesis of mediators including leukotrienes, chemokines and cytokines
    • clinical response includes smooth muscle contraction, airway obstruction, edema and airway hyperreactivity to bronchoconstrictory stimuli such as histamine and methacholine
  20. Treatments for asthma
    • combined inhaled glucocorticosteroid and long acting beta2-adrenergic receptor agonist
    • inhalded glucocorticosteroids (alone)
    • leukotriene receptor antagonists
    • inhaled beta2-adrenergic receptor agonists (alone) (short and long acting both)
    • monoclonal antibody, omilizumab (Xolair), blocks a pathway that the immue system uses to trigger asthma
    • mast cell stablizers
    • Methylxanthine derivatives
    • inhaled muscarinic receptor antagonists
  21. Characterizations of chronic bronchitis
    • inflammation of the bronchi
    • excessive secretions of mucus into the airways
    • airway narrowing of airway closure
    • two types: acute and chronic
  22. Causes of chronic bronchitis
    • cigarette smoking (#1 cause)
    • industrial fumes
    • automobile exhaust
    • microorganisms - bacterial or viral bronchitis
  23. Symptoms of chronic bronchitis
    persistent or prolonged: chest pain, dyspnea, cough, fever & chills
  24. Clinical presentation of patient may show
    • rhonchi (gurgling sounds during inspiration/expiration)
    • hypercapnia (elevated blood CO2 levels)
    • hypoxemia (decreased blood O2 levels)
    • respiratory acidosis
  25. Treatments of chronic bronchitis
    • combined inhaled glucocorticosteroid and long-acting beta2-adrenergic receptor agonist
    • inhaled glucocorticosteroids (alone)
    • inhaled beta2-adrenergic receptor agonists (alone) (short acting "rescue" and long-acting)
  26. Emphysema
    • involves damage to the lung air sacs affecting breathing, leading to:
    • progressive destruction of alveoli and the surrounding lung tissues
    • air trapping in the lungs due to a lack of supporting tissue, thus decreasing blood oxygenation
    • with advanced emphysema, large air cysts develop in the place of normal lung tissue causing atelectasis (collapse of part or all of a lung)
  27. Causes of emphysema
    • smoking (#1 cause)
    • alpha1-antitrypsin (AAT) deficiency
  28. Smoking and emphysema
    • second and possibly third-hand smoke contributes to emphysema in non-smokers
    • 4,000 chemicals in tobacco smoke
    • chemicals slowly destroy the small peripheral airways, the elastic air sacs and their supporting elastic fibers
  29. AAT deficiency and emphysema
    • ~1-2% of people have inherited form involving a deficiency in the protein AAT
    • AAT is a protease inhibitor made in the liver
    • AAT protects the elastic structures in the lungs from enzymes that can progressive lung tissue
    • AAT also protects the liver
    • Early onset emphysema (between 30-40) may occur in a smoker with a lack of AAT
  30. Symptoms of emphysema
    • shortness of breath
    • wheezing
    • chest tightness
    • reduced capacity for physical activity
    • chronic coughing
    • loss of appetite
    • fatigue
    • cyanosis
  31. Treatments for emphysema
    • combined inhaled glucocorticosteroid and long-acting beta2-adrenergic receptor agonist
    • inhaled muscarinic receptor antagonists
    • supplemental O2 therapy
    • pulmonary rehabilityation program (combines education, exercise training and behavioral intervention to stay active an improve health and quality of life)
    • lung volume reduction surgery (LVRS) - removal of diseased lung wedges to help remaining tissue work more efficiently and improve breathing
  32. Cystic fibrosis
    an inherited autosomal recessive disease that causes thick, sticky mucus to build up in the lungs and digestive tract
  33. Symptoms of cystic fibrosis
    • coughing or increased mucus production in the sinuses or lungs
    • nasal congestion and/or sinus pain or pressure caused by infection or nasal polyps
    • increased shortness of breath
    • fatigue
    • recurrent episodes of pneumonia
    • fever
    • loss of appetite
  34. Treatments for cystic fibrosis
    • antibiotics to prevent and treat lung and sinus infections
    • inhaled beta2-adrenergic receptor agonists with chest percussion, postural drainage and breathing control exercises
    • DNAse replacement therapy to thin mucus and make it easier to cough up
    • flu vacine and pneumococcal polysaccharide vaccine (PPV) yearly
    • supplemental O2 therapy
    • lung transplant
  35. Pneumoconiosis
    • results from inhaling particulate matter over a long period of time
    • particulate matter triggers lung inflammation causing lung damage
    • remodeling occurs forming tough, fibrous tissue deposits in damaged lung areas
    • fibrosis stiffens the lungs and interferes with O2 and CO2 exchange
  36. Types of pneumoconiosis
    • Coal Worker's pneumoconiosis
    • Talc pneumoconiosis
    • asbestosis
    • silicosis
    • Kaolin (china clay) pneumoconiosis
  37. Symptoms of pneumoconiosis
    • chronic cough
    • shortness of breath, especially with exercise
    • wheezing
    • low physical endurance
  38. Treatments of pneumoconiosis
    • combined inhaled glucocortiosteroid and long-acting beta2-adrenergic receptor agonist
    • supplemental O2 therapy
  39. Pleurisy
    inflammatino of the pleural linging of the lungs and chest
  40. Causes of pleurisy
    • pneumonia
    • tuberculosis
    • chest trauma
    • tumor formation
  41. Symptoms of pleurisy
    • pain in the chest during deep breathing (inhale or exhale)
    • cyanosis
    • coughing
    • shortness of breath
    • tachypnea
  42. Treatments of pleurisy
    • removal of fluid in the lungs by thoracentesis
    • antibiotics for bacterial infections; may require a surgical procedure to drain infected fluid
    • NSAIDs