asthma and copd presented by erin frankenberger & michelle wisniewski bio 313e pharmacology and...
TRANSCRIPT
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Asthma and COPDPresented by Erin Frankenberger & Michelle Wisniewski
BIO 313E Pharmacology and Pathophysiology II
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Objectives
•Differentiate between the clinical manifestations of Asthma and COPD
•Identify the various subtypes of COPD, including emphysema and chronic bronchitis
•Compare and contrast the treatment of Asthma and COPD
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COPD
• COPD, or chronic obstructive pulmonary disease, is a group of similar chronic respiratory diseases in which there is progressive tissue degeneration and obstruction within the airways of the lungs
• The destruction of the alveolar walls and septae leads to large, permanently inflated alveolar air spaces
• The resultant airway obstruction is not fully reversible
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COPD Fast Facts
•COPD typically has an adult-onset and a slow development and progression •A typical COPD patient has a history of smoking having smoked >20 cigarettes per day for more than 20 years•Less typically occurs in young adults with alpha-antitripsin deficiency
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COPD Fast Facts
•The first sign of COPD is a productive cough followed by progressive and persistent dyspnea that is made worse with exertion or respiratory infection•As the disease progresses, a morning headache becomes a sign of nocturnal hypercapnia or hypoxemia
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COPD Signs and Symptoms
• Symptoms are constant and progressive • Include shortness of breath, cough,
wheezing, increased expiratory phase, cyanosis, and barrel chest
• Symptoms of advanced COPD include weight loss and muscle wasting, which is attributed to immobility, hypoxia, or the release of systemic inflammatory mediators, such as TNF-a
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COPD Signs and Symptoms
• Clinical signs of COPD include pursed-lip breathing, use of accessory muscles, Hoover sign, hypoxia cyanosis, peripheral edema and cor pulmonale
• Signs of cor pulmonale include neck vein distension, splitting of the 2nd heart sound, tricuspid insufficiency murmer and peripheral edema
• Spontaneous pneumothorax may also occur
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COPD
•The two most common types of chronic obstructive pulmonary disease are chronic bronchitis and emphysema
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Chronic Bronchitis
• Chronic bronchitis results in inflammation in the airways of the lungs
• Thick mucus, a chronic cough, airway obstruction, and frequent infections are typical of this disease
• Chronic cough is accompanied by shortness of breath and tachypnea
• This disorder is differentiated from acute bronchitis in that the disease course is continuous and the duration is at least a year
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Chronic Bronchitis
• The excessive build up of thick mucus in the lungs results in narrowing of the bronchi
• The resultant narrowing of the airways leads to hypoxia, cyanosis and hypercapnia
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Emphysema
• Emphysema results in destruction of the alveolar sacs in the lungs
• The alveoli lose their elasticity and result in air trapping, or permanent alveolar air spaces
• Damage to the alveoli results in difficulty expelling oxygen poor air from the lungs, thus resulting in shortness of breath (SOB)
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Emphysema
• Initially, dyspnea occurs with activity and exertion, but as the disease progresses, occurs at rest
• Typical manifestations of emphysema include hyperventilation, “barrel chest”, and a forward-leaning posture to increase ease of breathing
• Other signs and symptoms include anorexia, fatigue, clubbed fingers and secondary polycythemia
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COPD Exacerbating Factors
•Smoking and inhalation of toxins or other respiratory irritants•Alpha1-antitrypsin deficiency (A1AD)•Viral upper respiratory infections•Acute bacterial bronchitis•Heart disease
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Treatment of Stable COPD
• Beta-agonists• Anticholinergics• Inhaled corticosteroids• Theophylline • Phosphodiesterase-4 inhibitors• Oxygen therapy
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Treatment of Acute COPD Exacerbation
• Oxygen supplementation• Bronchodilators• Corticosteroids• Antibiotics• Ventilator assistance
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Supportive Therapies for COPD
• Smoking cessation• Avoidance of air pollution• Pulmonary rehabilitation, including education,
exercise training, nutrition and social support • Exercise, such as walking, swimming or bicycling
and weight training for weight normalization and to decrease muscle wasting
• Vaccinations• Surgery, such as lung transplant or lung volume
reduction surgery
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Asthma
• Asthma is a respiratory disease involving episodes of bronchial obstruction in those with hypersensitive airways
• This obstruction is reversible, however frequent repeated episodes will cause irreversible damage in the lungs
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Asthma Fast Facts
• Can be acute or chronic• Two types, extrinsic or intrinsic• 15,000,000 children between the ages
of 5 to 17 have been diagnosed with asthma in the U.S.
• Attacks are often triggered by allergens or irritants
• Both types of asthma illustrate the same pathophysiologic changes involving inflammation
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Asthma Fast Facts
• Some exhibit asthma signs as a constant, where as some only experience marked episodes of asthma attacks
• Acute attacks are more common and are usually resolved fairly easily
• Severe attacks require immediate medical attention
• These severe attacks are called status asthmaticus
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Asthma Signs and Symptoms
• Typical signs and symptoms include cough, dyspnea, a feeling of pressure in the chest
• Signs of a cold including sneezing, runny nose, congestion, sore throat, and headache
• The individual will often not be able to talk
• Wheezing is also common, due to air trying to pass through restricted bronchioles
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Ashtma Signs and Symptoms
• Mucus is coughed up and can totally obstruct the airway
• Tachycardia along with changes in pulse rate on inspiration and expiration
• Rapid and labored breathing• Hypoxia• Fatigue and trouble sleeping• Feelings of irritability
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Ashtma Signs and Symptoms
• Hyperventilation can occur followed by respiratory alkalosis
• If hypoventilation occurs, hypoxemia will increase leading to respitatory acidosis
• If attack is not controlled, the result can involve respiratory failure
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Intrinsic Asthma
• Often has an onset in adulthood• Irritants and other factors are the
cause of asthma attacks rather than allergens
• Causative agent is unknown• The immune system is not involved in
this type of allergic reaction
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Intrinsic Asthma Exacerbating Factors
• Extreme emotions (crying)• Cigarette smoke• Cleaning agents• After exercising• Pollutants• Exposure to cold weather• Respiratory infections• Anxiety
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Extrinsic Asthma
• Acute episodes triggered by an allergen
• Commonly has family history• Onset is more commonly found in
children• Antigen reacts with immunoglobulin E
which releases chemicals including histamine and causes inflammation, bronchospasm, and an increase in mucous secretion
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Extrinsic Asthma Exacerbating Factors
• Dust and mold• Seasonal pollens• Smoke• Animal dander• Pollutants• Certain food (seafood, peanut butter,
soy)
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Treatment for Asthma
• Bronchodilators (inhalers)• Glucocorticoids• Steroids• Nebulizer• Leukotriene inhibitor (Singulair)• Antibodies (Xolair)
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Treatment for Asthma
• Treatment methods depend on the severity of asthma
• The bronchodilators are used more to control asthma attacks
• Leukotriene inhibitors and antibodies are more so for chronic asthma
• Medications like Singulair should be taken daily, even when there are no symptoms to prevent asthma attacks; it does not reverse bronchospasms
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Supportive Therapies for Asthma
• Stepwise therapy• Environmental control (elimination of
irritants such as smoke and dust)• Avoidance of foods that provoke
attacks• Skin tests to determine specific stimuli• Proper ventilation
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Supportive Therapies for Asthma
• Controlled breathing techniques • Walking and swimming strengthen
chest muscles and overall cardiovascular fitness
• Reduce factors that cause stress and anxiety
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References
• http://www.merckmanuals.com/professional/pulmonary_disorders/chronic_obstructive_pulmonary_disease_and_related_disorders/chronic_obstructive_pulmonary_disease_copd.html#v8575447
• http://www.merckmanuals.com/professional/pulmonary_disorders/asthma_and_related_disorders/asthma.html?qt=asthma&alt=sh
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654706/• Gould, B. & Dyer, R. (2011). Pathophysiology for the
health professions (4th ed.). St. Louis, MO: Saunders.
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References
• Asperheim, M.K. & Favaro, J. (2012). Introduction to Pharmacology (12th ed.). St Louis, MO: Saunders
• http://www.healthguidance.org/entry/10909/1/Extrinsic-Asthma-VS-Intrinsic-Asthma.html
• http://www.onhealth.com/asthma/page6.htm• http://www.aafa.org/display.cfm?id=8&sub=16