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Respiratory Pathologies

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Title: Respiratory Pathologies


1
Respiratory Pathologies
2
Asthma -Pathophysiology
  • Airway hyper-responsiveness reactivity
    (bronchospasm)
  • Airway inflammation
  • Response to a variety of triggers

3
Asthma - Pathophysiology
  • In everybody during 1st few minutes of
    exercise, bronchodilation occurs.
  • In asthmatics after 10 minutes of activity,
    their bronchioles return to baseline and can
    progress through bronchoconstriction, peaking
    5-10 minutes after stopping activity.
  • The bronchioles usually return to normal over
    20-40 minutes after activity.

4
Asthma Mechanism of Wheezing
  • Narrowing of airway
  • Airways pulled open during inhalation
  • Allowed to collapse during exhalation
  • Air forced past obstruction making noise

5
Asthma - Diagnosis
  • S/S
  • Exposure to trigger
  • Family Hx
  • Pulmonary Function Tests
  • Response to Tx

6
Asthma Common Triggers
  • Cold air
  • Allergens
  • Irritants smog, smoke, drugs
  • Stress emotional/physical
  • Laughing
  • Infections
  • Exercise

7
Exercise-Induced Bronchospasm
  • Exercise induced asthma
  • Symptoms ONLY seen with exercise
  • Occurs when?

8
Exercise Induced Brochospasm
  • Two Theories
  • A. Water-lose Theory
  • B. Heat-exchange Theory

9
EIA
  • Diagnosis
  • Frequently missed
  • Suspect in patients with
  • Try and reproduce s/s in a controlled environment
  • Trial/error of medications before exercise

10
EIA
  • A decrease of 10 in peak flow expiratory flow
    rate after exercise confirms a diagnosis of EIA.
  • History

11
Peak Flow Meters
  • Portable
  • Designated zone
  • Blow as hard and fast as possible
  • Establish baseline and then test often. (80) of
    function to participate.

12
Formal PFTs
  • Pulmonary Function Tests
  • Computerized
  • Graph Data

13
Asthma - Treatment
  • Prevention
  • Monitor Zones PLAN
  • Green Zone
  • Yellow Zone
  • Red Zone
  • Medication treatments goal either decrease
    inflammation or reduced bronchospasm

14
Treatments Inhalers
  • Meter Dose Inhalers (MDI)
  • puffers - beta-2-adrenergic agonist
  • Most commonly albuterol
  • ALWAYs use with a spacer
  • 2 puffs
  • Breathe in and hold
  • Proper use is key!

15
Dry Powder Inhalers
  • Inhalation of powder med
  • May work just as well as MDI
  • Advantages
  • Disadvantages

16
Alburterol/Pirbuterol
  • Bronchodilator
  • Side Effects
  • Onset of Action
  • Duration of Action
  • Allowable by USOC (c note) and NCAA
  • Albuterol will NOT work if on a beta-blocker

17
Salmeterol
  • Long-acting bronchodilator
  • Side-effects
  • Onset of action
  • Duration of action
  • NEVER for an acute attack

18
Cromolyn
  • Mast cell Stabilizer
  • Onset of Action
  • Duration of Action
  • Role in Exercise
  • Preventative med

19
Leukotriene Modifiers
  • Leukotrienes
  • Medications prevent chemical formation or binding
    of receptors
  • Works in approx. 50 of patients

20
Inhaled Corticosteroids
  • Daily
  • Not used in isolated EIB
  • Reduced incidence of steroid side effects because
    it is inhaled
  • Trush

21
Multimodal Therapy
  • Patients are on many forms of medications
  • Patients on daily therapy STILL need to use
    rescue medications (albuterol)

22
Keys to EIB Therapy
  • Treatment
  • Medication before exercise
  • Daily meds needed if underlying asthma is an
    issue
  • Utilization of refractory period
  • Self-selection of sports
  • Rule of 2s

23
ALL That Coughs is not Asthma
  • Differential Diagnosis

24
Other options
  • Paradoxical Vocal Cord Dysfunction
  • Hyperventilation
  • Anxiety Attack
  • Reflux (GERD)
  • Upper respiratory infection
  • Exercise-induced anaphylaxis
  • Lung diseases
  • Pneumonia
  • Lymphoma
  • Heart failure

25
Vocal Cord Dysfunction (VCD)
  • Vocal cords close during inspiration
  • Will NOT respond to traditional treatments meds
    or refractory period
  • Part of the issue is psychological
  • gt in women
  • s/s
  • Tx

26
GERD
  • Gastroesophageal reflux
  • Can make asthma VCD worse
  • s/s
  • Tx

27
Upper Respiratory Infection
  • The common cold
  • s/s
  • Tx
  • Modify activity based on energy level.

28
Exercised-induced anaphylaxis
  • Rare literally allergic to exercise!
  • Triggered by exercise
  • s/s
  • Tx

29
Pneumonia
  • Viral or bacteria
  • Diagnosis chest x-ray
  • Must have
  • 1. deep wet cough
  • 2. fever

30
Pulmonary auscultations
Use of stethoscope to identify NORMAL BREATH
SOUNDS Stethoscope placement 4
quadrants Abnormal sounds wheezing, rales,
stridor Pathological breathing patterns apnea,
tachypnea, bradypnea, dyspnea,
hyperventilation obstructed airway
31
Summary
  • Asthma is a diagnosable treatable disease
  • Asthmatics should know their disease
  • Exercise may trigger asthma in asthmatics, or it
    may be isolated EIB
  • The best treatment is prevention
  • Medicinal treatments MUST be customized
  • Other diseases that are life-threatening may
    present with a cough
  • Know what is banned by various athletic
    organizations
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