CHAPTER 20 Respiratory Disorders
I. Asthma
A. Background
2. In people with asthma, the air passages within the lungs are constantly swollen, which restricts the amount of air that can pass through the trachea.
4. According to the American Lung Association, approximately 20 million Americans have asthma, which causes about 5000 deaths each year.
5. There is no cure for asthma, but many medications and lifestyle changes help manage the condition.
B. Classifications
1. There are various classifications of asthma. These conditions cause airway obstruction and inflammation that is partly reversible by medication. The symptoms are usually similar; however, the main difference is their cause.
a. Allergic (extrinsic) asthma
(1) An allergic reaction triggers allergic asthma, which is an immune system response that causes the airway to become inflamed.
C. Pathophysiology
1. Because asthma is an inflammatory process, several cells (mostly immune system–mediated cells) have been identified as playing a role in the disease process (Figure 20-1).
2. There are three major parts of the immune system response
D. Signs and symptoms
1. Asthma symptoms may appear at any time in life. Individuals who develop asthma as adults have adult-onset asthma. This condition may develop as late as age 50 or older. Unlike children, who usually experience intermittent symptoms, individuals with adult-onset asthma are more likely to experience persistent symptoms. The cause of adult-onset asthma is unknown. However, some evidence suggests that allergy and asthma may be genetically determined. In addition, obesity, which has both genetic and environmental influences, appears to significantly increase the risk of developing asthma in adulthood. The following symptoms may occur in any age group, unless otherwise noted.
E. Diagnosis
F. Treatment
1. Short-term relief: bronchodilation
a. Beta-2 adrenoceptor agonists
(5) Short-acting: used for quick relief of asthma symptoms
2. Long-term control: anti-inflammatory medications (asthma “controllers”)
b. Leukotriene inhibitors (Figure 20-3)
II. Chronic Obstructive Pulmonary Disease
A. Background
1. Chronic obstructive pulmonary disease (COPD) is a type of lung disease that involves damage to or obstruction of the airways of the lungs, which makes it difficult to breathe. COPD is an overall term referring to a group of chronic lung conditions, including chronic bronchitis and emphysema and possibly asthma or asthmatic bronchitis. Although chronic bronchitis and emphysema may occur separately, it is common for patients to have both diseases simultaneously.
2. The Centers for Disease Control and Prevention (CDC) report that COPD affects up to 24 million Americans. The main risk factor for COPD is smoking. COPD is most likely to develop in cigarette smokers, but cigar, pipe, and marijuana smokers also are susceptible. The risk of COPD is directly related to the number of years a person smokes and the amount smoked. Researchers estimate that smoking causes 80%–90% of COPD deaths. According to the American Lung Association, COPD is the fourth leading cause of death in the United States. Patients with COPD typically die from complications, such as severe lung infections, heart problems, or lung cancers. The American Lung Association also states that female smokers are nearly 13 times more likely to die from COPD than women who have never smoked and male smokers are nearly 12 times more likely to die from COPD than men who have never smoked.
B. Signs and symptoms
1. Symptoms of COPD usually develop gradually over many years and typically worsen over time.
a. Chronic bronchitis or emphysema (or both)
III. Cystic Fibrosis
A. Background
1. Cystic fibrosis (CF), also called mucoviscidosis, is an inherited life-threatening disorder that causes severe lung damage and nutritional deficiencies. CF causes the body to produce abnormally thick and sticky mucus, saliva, sweat, and digestive enzymes. In healthy individuals, these secretions serve as lubricants in the body. In patients with CF, however, the secretions are so thick that they plug up tubes and passageways in the body. The lungs and pancreas are the most commonly affected organs.
B. Signs and symptoms
1. Symptoms of CF vary among patients. Some patients experience severe symptoms that affect the lungs as well as the digestive and reproductive systems. Others may experience milder symptoms that affect fewer parts of the body. In some cases, severity of symptoms changes as patients get older.
2. In newborns, the first sign of CF may be a blockage of the intestines. Healthy babies normally pass greenish-black stools, called meconium, during their first couple days of life. However, if the infant has CF, the meconium may be too thick to move through the intestines. Other signs and symptoms include oily stools, failure to grow, and frequent lung infections.
Figure 20-1 Airway changes during asthma.
(From Gould BE: Pathophysiology for the health professions, ed. 3, St. Louis, 2007, Saunders)
Figure 20-2 Nebulizer.
(From Hopper T: Mosby’s pharmacy technician, ed. 2, St. Louis, 2007, Saunders)
Figure 20-3 Leukotriene pathway.
(From Moscou K, Snipe K: Pharmacology for pharmacy technicians. St. Louis, 2009, Mosby)
PATIENT PROFILE
Allergies: No known drug allergies (NKDA)
Social History: Tobacco use: Former heavy smoker; quit 5 years ago when husband died of lung cancer
Centrum Silver 1 tablet PO once daily
Spiriva Handihaler 1 capsule inhaled once daily in the morning
Simvastatin 40 mg PO once daily at bedtime
Mucinex 1 tablet PO twice daily
Levaquin 500 mg once daily for 5 days (continuation of medication from hospital)
Clarithromycin 500 mg PO twice daily for 5 days (continuation of medication from hospital)
Advair inhaler 1 inhalation twice daily
PATIENT PROFILE QUESTIONS
1. What is the most likely reason that SV is asked to discontinue simvastatin at this time?
2. Upon review of SV’s medications, the pharmacist realizes that SV has become confused about her oral medications and her inhaled medications and has been taking the Spiriva capsules orally every morning in the past few weeks. Which of the following would be the most helpful tactic to encourage proper medication use and limit confusion?
b. She could store the inhaler medications in a different location on the counter in her home, separate from her oral medications
3. To ensure adequate treatment with her antibiotic therapy, SV should be advised to do which of the following?
REVIEW QUESTIONS
(Answers and Rationales on page 375.)
13. Which of the following drugs is useful in COPD for its strong anticholinergic effects and low side-effect profile?
18. A 15-year-old girl presents to the emergency department with an acute asthma exacerbation. Which of the following is the most appropriate initial treatment?
28. A 70-year-old man with coronary artery disease is prescribed theophylline for emphysema-associated bronchospasm. Which of the following is NOT likely to occur in this patient?
