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constituents of upper airways
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constituents of central airways
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constituents of peripheral airways
alveoli (pulmonary)
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what makes the airways very effective at increasing air temp & humidity?
large surface area & rich blood supply
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particles trapped in mucus are removed from airways by coordinated ciliary beating towards pharynx
mucociliary escalator
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3 airway defenses
- 1) filtration
- 2) mucociliary escalator
- 3) nerves/reflexes
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afferent nerves of the airways (2)
- C-fibers
- irritant receptors
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efferent nerves of the airways (3)
- 1) cholinergic
- 2) nitrergic
- 3) tachykinergic
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what nerves influence cilia beat rate?
cholinergic (efferent) nerves
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measures lung volumes & capacities
spirometry
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volume of air in lungs at full inspiration
total lung capacity
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volume of air remaining in lungs after max expiration
residual volume
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what happens to residual vol in pt experiencing severe bronchoconstriction?
increased residual vol
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FEV1
forced expiratory volume in 1 second
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determined from a spirometer trace
FEV1 & FVC
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what is % predicted FEV1 normalized to?
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ratio that is useful measure of pulmonary fcn
FEV1.0/FVC
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%predicted FEV1 in mild COPD
 80%
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%predicted FEV1 in severe COPD
<30%
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simplest measure of expiratory flow - measure max flow rate of expiration
peak flow measurement
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what happens to peak expiratory flow rate of a pt experiencing bronchoconstriction?
decreased peak expiratory flow rate
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influences airway mucus
neural & inflammatory mediators
(HA, leukotrienes)
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which pulmonary disease is mucus most viscous - asthma, CF, or COPD?
asthma
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2 ways in which mucus is cleared from affected airways
- 1) mucociliary escalator
- 2) coughing
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liquid mucus floats on, containing lysozymes w/ antibacterial fcn
sol layer
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3 things mucus clearance is affected by
- 1) mucus viscosity
- 2) mucus volume
- 3) ciliary beat frequency
-
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what peripheral sensitization does to cough sensitivity
increases cough receptor sensitivity
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MOA of mucolytics
- mucus removal facilitated by decreased mucus viscosity by:
- a) dec mucin molecule crosslinking
- b) degrading DNA/proteins
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MOA of N-acetylcysteine
mucolytic that decreases mucin molecule crosslinking by reducing disulfide bonds (contains a free thiol group)
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N-acetylcysteine contraindication
pts w/ advanced chronic bronchitis (mucus is already fairly liquid)
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MOA of dornase alpha
mucolytic that hydrolyzes extracellular DNA to decrease mucus viscosity
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MOA of hypertonic saline & mannitol
(expectorant) osmotic stimuli that promote fluid flow from epithelium into mucus
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MOA of guaifenesin
(expectorant) that irritates gastric mucosa to inc respiratory secretions & dec mucus viscosity
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MOA of codeine & hydrocodone
centrally acting antitussives act on opioid receptors to increase cough threshold & depress cough reflex
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MOA of dextromethorphan & levopropoxyphene napsylate
(antitussive) opiate derivatives
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MOA of benzonatate
peripherally acting antitussive that inhibits pulmonary stretch R's
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MOA of menthol on airways
peripherally acting antitussive serves w/ local anesthetic effect on sensory nerves
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3 ways bronchodilators reverse bronchoconstriction acutely
- 1) direct relaxation of airway SM
- 2) amplification of relaxation pathways
- 3) inhibition of bronchoconstrictor stimuli
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bronchodilators that directly relax airway SM
2-adrenoceptor agonists
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bronchodilators that amplify relaxation pathways
methylxanthines
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bronchodilator that inhibits bronchoconstrictor stimuli
muscarinic cholinoceptor antagonists
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list 5 SABA's
- 1) albuterol
- 2) levalbuterol
- 3) metaproterenol
- 4) pirbuterol
- 5) terbutaline
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list 2 LABA's
- 1) formoterol
- 2) salmeterol
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list 1 ultra-LABA
indacaterol
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list 2 non-selective 2-adrenoceptor agonists
- 1) epinephrine
- 2) isoproterenol
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MAIN MOA of 2-adrenoceptor agonists
relax airway smooth muscle
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indication for b2-adrenoceptor agonists
acute exacerbations of asthma
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MOA of theophylline & aminophylline
- (methylxanthines)
- 1) relax airway SM by inhibiting PDE3 or PDE4 leading to increased cAMP
- 2) inhibit adenosine R's
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bronchodilator that can cause seizures as a SE
methylxanthines
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MOA of ipratropium bromide, tiotropium, & aclidinium
(muscarinic antagonists) relax airway SM by inhibiting parasympathetic bronchoconstriction
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contraindications for muscarinic antagonists
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MOA of corticosteroids in asthma
decrease airway inflammation
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list 8 CCS's
- 1) beclomethasone
- 2) budesonide
- 3) ciclesonide
- 4) flunisolide
- 5) fluticasone
- 6) mometasone
- 7) prednisolone
- 8) triamcinolone acetanide
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MOA of cromolyn sodium & nedocromil sodium
(mast cell stabilizers) dec activation of eosinophils, neutrophils, & monocytes
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MOA of roflumilast
phosphodiesterase inhibitor (PDE4) increases intracellular cAMP to dec inflammatory mediator release
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MOA for zafirlukast & montelukast
leukotriene R antagonists
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MOA for zileuton
5-LOX inihibitor inhibits leukotriene synthesis
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MOA of omalizumab
IgE binding Ab that binds to the Fc epsilon R-1 portion of circulating Ab's to prevent their binding to mast cels
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