Case study 2 (asthma)

Question 1

Describe asthma

Answer 1

Chronic inflammatory airway disease

Question 2

What happens to the airways of people who suffer from asthma

Answer 2

Hyperactive airways respond to various stimuli by widespread inflammation
Muscles around the airways tighten, making airways narrower
The airway lining also becomes inflamed, causing a build-up of sputum
Airways become even narrower
Airflow to lungs is restricted

Question 3

Describe how an asthma airway would look during an attack

Answer 3

Tightened muscle around the airway

Inflammation and increased sputum leads to a narrowed passageway

Question 4

Name some symptoms of asthma

Answer 4

Coughing
Dyspnoea (difficulty breathing)
Wheeze
Chest tightness

Question 5

What are some triggers of asthma

Answer 5

Pollen
Pollution
Cold weather
Smoking
Irritants (animal hair)

Question 6

Name 2 types of asthma

Answer 6

Exercise-induced asthma

Allergy-induced asthma

Question 7

Describe the structure of the airways

Answer 7

Upper Respiratory Tract
•Nose (mouth)
•Pharynx
•Larynx
Lower Respiratory Tract
•Trachea
•Bronchi
•Bronchioles
•Alveoli

Question 8

Name the role of the nose in the respiratory tract

Answer 8

Warms, humidifies and filters air (cilia)

Question 9

Describe the role of the trachea in the lower respiratory tract

Answer 9

• Trachea “windpipe” descends from the larynx into the thorax
• Walls contains C-shaped rings of cartilage supporting the anterior and lateral aspects
• Cartilage helps to prevent tracheal collapse during pressure changes
• Trachea bifurcates (splits) at the carina

Question 10

Where does the bronchi begin?

Answer 10

•Trachea bifurcates at the carina into the R and L main (primary) bronchi

Question 11

Where does gaseous exchange occur?

Answer 11

Alveoli

Question 12

How do the respiratory bronchioles join to the alveolar sac

Answer 12

Respiratory bronchioles joined to alveolar sac via alveolar duct

Question 13

What is the thoracic cage comprised of?

Answer 13

• Ribs
• Sternum
• Thoracic vertebra

Question 14

Describe typical ribs

Answer 14

• Pairs 2-9
• Curved bone
• Posterior end has a head which articulates with 2 vertebral bodies
• Anterior end continuous with costal cartilage which articulates with sternum

Question 15

Describe atypical ribs

Answer 15

• Rib 1
• Flat in the horizontal plane
• Broad superior and inferior surfaces
• Articulates with the body of T1 (thoracic vertebrae) only

Question 16

What are the 3 elements of the sternum?

Answer 16

3 elements:
•Manubrium
•Body
•Xiphoid process

Question 17

What muscles work during inspiration?

Answer 17

• Diaphragm

* External intercostals

Question 18

What muscles work during active expiration?

Answer 18

• Internal intercostals
• Rectus abdominis
• Transversus abdominis
• Internal and external obliques

Question 19

Are expiration and inspiration active or passive?

Answer 19

•Inspiration is an active process requiring energy •Expiration is largely a passive process, but we occasionally actively expire too

Question 20

Describe how inspiration occurs

Answer 20

• Controlled by autonomic nerve impulses from the respiratory centre in the medulla oblongata in the brainstem
• Nerve stimulation causes contraction of the diaphragm and the external intercostals this expands the thoracic cage and lungs
• Expansion creates a lower pressure relative to the outside of the body
• Air rushes in

Question 21

Describe how relaxed expiration occurs

Answer 21

• Expiration is normally a passive process (i.e. requires no energy)
• Brought about by relaxation of the diaphragm and external intercostal muscles
• This allows for the elastic recoil of the lung tissue

Question 22

Describe how forced expiration occurs

Answer 22

• Contraction of the abdominal muscles causes the abdominal contents to push up against the diaphragm – reduces the vertical diameter of the thorax
• Contraction of the internal intercostals depress the ribs and decrease space in the thorax

Question 23

Where does the control of breathing occur?

Answer 23

respiratory control centres in the brainstem

Question 24

Name the movement of gas for the movement of air from the atmosphere to alveoli

Answer 24

Bulk flow

•Occurs due to a pressure difference during inspiration in alveoli (lower) compared to the atmosphere (higher)

Question 25

What is partial pressure measured in?

Answer 25

Partial pressures are measured in kilopascals (kPa) or millimetres of mercury (mmHg)

Question 26

Where does gaseous exchange occur at the lungs?

Answer 26

Occurs at the respiratory membrane | - the alveolar air space and the blood capillaries

Question 27

What characteristics of the respiratory membrane make it ideal for gaseous exchange

Answer 27

* Large surface area provided by the large number of lung alveoli * Very thin membrane so small depth for diffusion (1-2000ths of a millimetre)

Question 28

Name the channels that can be used to bypass the normal route of airways to the alveoli

Answer 28

``` Channels of Martin - Bronchiole-bronchiole Canals of Lambert - Bronchiole-alveolar Pores of Kohn - Alveolar-alveolar ``` Collateral ventilation

Question 29

What is the role of the mucociliary transport system?

Answer 29

provides the means for drainage of secretory products and particulate matter out of the sinuses.

Question 30

What type of muscle lines the airways

Answer 30

Airway smooth muscle spans from the trachea to bronchioles

Question 31

What nervous system is responsible for controlling the airways and how do the nerves act?

Answer 31

Parasympathetic nervous system | The parasympathetic nerves are autonomic (involunatry)

Question 32

What type of inhaler would you recommend, how does it help and when do you use it?

Answer 32

Reliever inhaler (blue) - relax the muscles around the airways - airways open wider and easier to breath - short-acting - use the inhaler as soon as you notice the symptoms

Question 33

What tips for breathing would a physio recommend and why?

Answer 33

- breathe slowly through the nose, not the mouth - keeps the air warm and moist - less sensitive to airways

Question 34

What exercise would you recommend and what are the benefits?

Answer 34

Walking, yoga, and swimming. Low impact aerobic exercises, preferably inside to avoid cold air - raises HR, increases lung power and stamina, reducing breathlessness - supports the immune system, helping to fight cold and viruses - reduces stress by releasing endorphins.

Question 35

What are some risk factors that increase your chance of asthma?

Answer 35

- family history - exposure to tobacco smoke as a child - mother smoking during pregnancy - bronchiolitis (childhood lung infection)

Question 36

What complications can asthma have on daily living?

Answer 36

- feel tired all the time - stress, anxiety, depression - lung infections - delays in growth - severe asthma attacks can be life-threatening

Question 37

How can steroid tablets help asthma sufferers?

Answer 37

Taken either as: - immediate treatment when you have an attack OR - used every day as a long-term treatment to prevent symptoms

Question 38

What surgery can be provided and for whom?

Answer 38

Bronchial thermoplasty - thin, flexible tube placed down throat, into the lungs - heat applied to airway walls, which reduces the excess smooth muscle tissue - allows airways to open wider - offered for severe asthma sufferers