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Asthma and Bronchiectasis

Rt-212 C/P Pathophysiology
Allegany College of Maryland
Respiratory Therapist Program
Etiology of Asthma
Divided into major types according to
precipitating factors:
Extrinsic asthma
Caused by external or environmental factors
Intrinsic asthma
Occurs in the absence of antigen-antibody
response
Extrinsic Asthma
AKA as allergic asthma
Caused by antigenic agents such as
pollen, grass, weeds, dust, dust mites,
animal danders, and food perservatives.
In susceptible pts, the hypersensitive
immune response creates acute and
chronic inflammation
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Intrinsic Asthma
AKA nonallergic or nonatopic asthma
Not directly linked to a specific antigen
Have a normal IgE
Usually begins at the age of 40 years
Caused by non-specific stimuli
Intrinsic Asthma (p. 223)
Infections (bacterial, viral, RSV, rhinovirus)
Exercise or Cold Air
Industrial pollutants
Drugs, Food Additives, and Preservatives (NSAIDS, ASA)
GERD
Sleep
Emotional Stress
Premenstrual Asthma
Pathology
Smooth muscle constriction of bronchial
airways
Excessive production of thick tenacious
secretions
Hyperinflation of the alveoli
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Clinical Manifestations of Asthma
respiratory rate
heart rate, cardiac output, and BP
Use of insp. and exp accessory muscles
Pursed lip breathing
Substernal intercostal retractions
Clinical Manifestations of Asthma
A/P chest diameter
Cyanosis
Cough and sputum production (IgE and
other WBCs cause purulent sputum)
Pulsus paradoxus (change in intrapleural
pressure)
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Clinical Manifestations of Asthma
Chest Assessment
Expiratory prolongation
Decreased tactile and vocal fremitus
Hyperresonant percussion note
Diminished breath and heart sounds
Wheezing and rhonchi
Chest X-ray (CXR) (p. 131 Bx 8)
Pulmonary Function Findings
in expiratory maneuvers
FVC, FEF
200-1200
, FEF
25-75%
, FEV
1
, PEFR,
and FEV
1
/FVC
Lung Volumes/Capacities
volumes such as; VT, RV, FRC, RV/TLC,
and TLC
in VC, and IC
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Arterial Blood Gases
Mild to Moderate Asthmatic Episode
Acute alveolar hyperventilation with
hypoxemia
Severe Asthmatic Episode
Acute ventilatory failure with hypoxemia
Increased shunt and normal a-v DO
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Abnormal Laboratory Tests
Sputum
Usually thick, white
Yellow, infection
Eosinophils
IgE
Increased level (extrinsic or allergic)
General Management
Patient self-monitor peak flow meter
Asthma Zone Management
Environmental control
Respiratory Care treatments
Oxygen therapy
Bronchial hygiene
Aerosolized medications
Mechanical ventilation
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Asthma Zone Management
Environmental control
General Management
Medications
Xanthines
Corticosteroids
Anti-inflammatory (Cromolyn Sodium)
Leukotriene inhibitors
Monitoring
Patient Compliance
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Bronchiectasis (Etiology)
Acquired Bronchiectasis
Pulmonary infections (repeated)
Bronchial obstruction (tumor masses )
Pulmonary tuberculosis
Congenital Bronchiectsis
Kartageners Syndrome (triad)
Hypogammaglobulinemia (AIDS)
Cystic Fibrosis
Bronchiectasis Pathology (p.205)
Varicose (fusiform)
Distorted, bulbous shape
Cylindrical (tubular)
Similar to a tube
Saccular (cystic)
Cystlike sacs
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Pathology
Chronic dilation and distortion of bronchial
airways
Excessive production of often foul-smelling
sputum (layered)
Smooth muscle constriction
Hyperinflated alveoli
Atelectasis, consolidation, and parenchymal
fibrosis
Clinical Manifestations
RR, HR, CO, BP
Use of accessory muscles on inspiration
and expiration
Pursed-lip breathing
AP diameter (air-trapping)
Cyanosis
Clinical Manifestations
Digital clubbing
Peripheral edema/JVD
Cough, Sputum, and hemoptysis
Chest Assessment (obstructive vs.
restrictive p. 208)
Pulmonary Function
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Arterial Blood Gases
Mild to Moderate
Acute alveolar hyperventilation with
hypoxemia
Severe
Chronic ventilatory failure with hypoxemia
shunt
Abnormal Laboratory Tests
Hematology
Increased H&H
Electrolytes
Hypochloremia
Sputum Examination
Strep pneumoniae
H. flu
Pseudomonas aeruginosa
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Radiologic Findings
CXR
Translucent, depressed & flattened diaphragms, long
&narrow heart, cardiomegally
Bronchogram
Has been replaced by CT scan
CT Scan
Increased bronchial wall opacity
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General Management
Respiratory Care Treatments
Oxygen therapy
Bronchial hygiene
Aerosolized medication
Mechanical ventilation
Medications
Xanthines
Expectorants
Antibiotics