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Figure 13-1. Asthma. DMC, Degranulation of mast cell; SMC, smooth muscle constriction; MA, mucus accumulation; MP, mucus plug; HALV, hyperinflation of alveoli.
Slide 1 Copyright 2006 by Mosby, Inc.
Smooth muscle constriction of bronchial airways (bronchospasm) Excessive production of thick, whitish, tenacious bronchial secretions Hyperinflation of alveoli (air-trapping) Mucus plugging and, in severe cases, atelectasis
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Etiology
Extrinsic asthma
Intrinsic asthma
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Intrinsic Asthma
(Nonallergic or Nonatopic Asthma)
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Infections Exercise and cold air Industrial pollutants or occupational exposure Drugs, food additives, and food preservatives Gastroesophageal reflux Sleep (nocturnal asthma) Emotional stress
Premenstrual asthma
Copyright 2006 by Mosby, Inc.
Residence in a large urban area, especially the inner city Exposure to secondhand smoke A parent who has asthma Respiratory infections in childhood
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Increased respiratory rate Increased heart rate, cardiac output, blood pressure
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Use of accessory muscles of inspiration Use of accessory muscles of expiration Pursed-lip breathing Substernal intercostal retractions Increased anteroposterior chest diameter (barrel chest) Cyanosis Cough and sputum production
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Decreased blood pressure during inspiration Increased blood pressure during expiration
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Expiratory prolongation Decreased tactile and vocal fremitus Hyperresonant percussion Diminished breath sounds Diminished heart sounds Wheezing and rhonchi
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Figure 2-17. As air trapping and alveolar hyperinflation develop in obstructive lung diseases, breath sounds progressively diminish. Copyright 2006 by Mosby, Inc.
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VC
IC
ERV
RV/TLC ratio
N or
N or
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pH
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Alveolar Hyperventilation
PaO2 or PaCO2
70 60 50 40 30 20 10 0
PaO2
Figure 4-2. PaO2 and PaCO2 trends during acute alveolar hyperventilation.
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pH
PaCO2
HCO3PaO2 (Significantly)
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Alveolar Hyperventilation
Point at which disease becomes severe and patient begins to become fatigued
Oxygenation Indices
QS/QT DO2 VO2 Normal C(a-v)O2 Normal
O2ER
SvO2
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Sputum examination Eosinophils Charcot-Leyden crystals (see next slide) Casts of mucus from small airways
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Charcot-Leyden Crystals
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Radiologic Findings
Chest radiograph
Increased anteroposterior diameter Translucent (dark) lung fields Depressed or flattened diaphragm
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Figure 13-4. Chest X-ray of a 2-year-old patient during an acute asthma attack.
Slide 28 Copyright 2006 by Mosby, Inc.
Step 4:
Step 3: Step 2:
Continual symptoms
Daily symptoms Symptoms > than twice weekly
Step 1:
From McCance KL, Huether SE: Pathophysiology: The biologic basis for disease in adults and children, ed 4, St. Louis, 2002, Mosby.
Slide 29 Copyright 2006 by Mosby, Inc.
Green zone
Yellow zone
Red zone
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Xanthines
Corticosteroids
Anti-inflammatory agents Leukotriene inhibitors
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Monitoring
Arterial blood gas measurements Pulse oximetry Serial PFTs PEFR FEV1 Vital signs Chest radiographs
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Patient compliance
Asthma-symptom/medication-use diaries Serum theophylline levels Carboxyhemoglobin determinations Total (circulating) eosinophil counts No-show rates at physician offices Rate of medication use Frequency of emergency department visits and hospitalizations
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Classroom Discussion
Case Study: Asthma
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