NUR 239 Lecture Notes - Lecture 18: Obstructive Lung Disease, Bronchoconstriction, Immunoglobulin E
21 May 2018
School
Department
Course
Professor
NUR 239/Pathophysiology and Pharmacotherapeutics in Nursing I
Unit 4/Frandsen Chapter 33 - Drug Therapy for Asthma and Bronchoconstriction & Chapter 22 – Drug Therapy for TB
Complete the following study guide and submit on Reggie Net by the due date on the Course Calendar
You should have an understanding of all the key terms at the beginning of each Chapter.
Key Learning Objectives - Answer the follow questions (Frandsen Chapter 33 - Drug Therapy for Asthma and
Bronchoconstriction):
▪ The causes of asthma are unknown. What are the factors thought to contribute to the development of
asthma? When do people develop asthma?
o It appears to involve the relationship between host factors (genetic) and environmental exposures
that occur at a critical time in immune system development. The strongest identifiable
predisposing factor for asthma seems to be the genetic predisposition for the development of an
immunoglobulin E mediated response to common allergens.
▪ Many stimuli initiate the two main factors that cause asthma symptoms, name the two factors.
o Viral infections and environmental factors
▪ Describe the causative agents and common triggers of asthma. Weather and environmental temperatures
can trigger asthma symptoms, is hot or cold more likely to cause problems?
o Pollen, olds, indoor allergens (dust mites, dander, molds) respiratory irritants (smoke from
cigarettes and occupational environment).
▪ What drugs are likely to precipitate an asthma attack? → NSAIDs
▪ Describe the relationship between asthma symptoms and GERD.
o Asthma that worsens at night may be associated with night-time acid reflux. Although the
mechanism of GERD in asthma I not known, experts suggest that microaspirations or a vagally
mediated, reflex type of bronchoconstriction may be involved. Asthma, in turn, may also
aggravate GERD< because anti-asthma medications that dilate the airways also relax muscle tone
in GERD sphincter and may increase acid reflux. The results of randomized trials of acid
suppression therapy suggest that GERD is most likely not a contributor to asthma in patients
without esophageal reflux symptoms.
▪ Briefly describe the pathophysiology of asthma.
o Brochospasm involves strong muscle contractions that narrow the airways. Airways mooth muscle
extends from the trachea thru the bronchioles, and wraps around the airways in a spiral pattern.
Inflammation, mucosal edema, and excessive mucus aggravate bronchoconstriction, and numerous
stimuli described previously may precipitate it.
▪ Use Box 33.1 to describe Chronic Bronchitis and Emphysema. When a patient has both conditions, what
is their diagnosis?
o COPD develops after long-standing exposure to airway irritants such as cigarette smoke. The
conditions are also known as chronic obstructive lung disease, or chronic airflow limitation.
▪ Under the heading Drug Therapy (p. 637), what is the management of asthma involve? What medication
is the most common first-line choice for asthma symptoms?
o Management of asthma involves prevention of airway inflammation and avoidance of triggers for
better symptom control. Anti-inflammatory drugs, such as corticosteroids, leukotriene modifiers,
mast cell stabilizers, and immunosuppressant monoclonal antibodies, are used to prevent and treat
inflammation of the airways. Bronchodilators used to prevent/treat bronchoconstriction include
adrenergics, anticholinergics, and xanthines.
▪ In Box 33.2, there are guidelines for Quick Relief and Long-term Control, describe both in the adult
patient.
find more resources at oneclass.com
find more resources at oneclass.com
NUR 239/Pathophysiology and Pharmacotherapeutics in Nursing I
Unit 4/Frandsen Chapter 33 - Drug Therapy for Asthma and Bronchoconstriction & Chapter 22 – Drug Therapy for TB
Complete the following study guide and submit on Reggie Net by the due date on the Course Calendar
o Quick Relief: Short-acting, inhaled, beta2 agonist, 2-4 puffs as needed; if symptoms are severe,
patients may need up to three treatments at 20 minute intervals or a nebulizer treatment. A short
course of a systemic corticosteroid may also be needed.
o Long Term Control:
▪ Step 1 Mild Intermittent (symptoms less than or equal to 2 days/week or less than or equal
to 2 nights/month: no daily medication needed; treat acute exacerbations with inhaled beta
2 agonist and short course of systemic corticosteroid. Alternative: regular low-dose inhaled
steroid for pt. with risk of asthma exacerbations.
▪ Step 2: Mild Persistent (symptoms greater than 2/week but less than 1/day or greater than 2
nights/month
• Low-dose inhaled corticosteroid plus short-acting beta 2 agonist is preferred.
▪ The Adrenergics drug class has two types of medications used to control asthma symptoms. Describe both
types.
o 1) Rescue inhalant medications (quick-relief, short-acting drugs) used during periods of acute
symptoms and exacerbations
o 2) Maintenance inhalant medications (long-term control drugs used to achieve and maintain
prophylactic control of persistent asthma)
▪ Box 33.3 (p. 640) show two types of beta-2 adrenergic agonist. How are albuterol and salmeterol used in
the treatment of asthma? HINT- it may be easier to look them up in your drug book!
o Albuterol stimulates beta2- adrenergic receptors in the smooth muscle of bronchi and bronchioles.
The receptors then stimulate the enzyme adenyl cyclase to increase production of cyclic AMP.
o Salmetrol works by relaxing muscles and opens air passages in the lungs, which makes it easier to
breathe.
▪ Epinephrine would be used in what type of situation? What drug class is it in? How quickly does it work?
o Epinephrine is used in an acute attack of bronchoconstriction, with therapeutic rescue effects in
apx. 5 minutes and lasting for apx. 4 hours.
▪ Use Box 33.4 to summarize the Patient Teaching Guidelines for Antiasthmatic drugs.
o Asthma & chronic lung diseases are characterized by constant inflammation of the airways and
periodic/persistent labored breathing from constriction/narrowing of the airways. Antiasthmatic
drugs are given in combo to combat these problems.
o When an asthma attack occurs, only the fast-acting commonly used medication to relieve these
symptoms is an inhaled, short-acting bronchodilator.
o A common cause of asthma attacks is not taking medications correctly. Some studies indicate that
1/3-2/3 of patients with asthma don’t comply with instructions for using their medications. If
unable to prevent symptoms, early recognition and treatment may help prevent severe distress and
hospitalizations. Signs of impending difficulty include increased needs for bronchodilator inhalers,
activity limitations, waking at night because of asthma symptoms, and variability in the peak
expiratory flow rate.
▪ How do corticosteroids help in the treatment of asthma (p. 647)?
o Most consistently effective long-term control medication for asthma. They suppress the release of
the inflammatory mediators, block the generation of cytokines, and decrease the recruitment of
airway esoniphils. The drugs increase the number and sensitivity of beta 2-adrenergic receptors,
which restores/increases the effectiveness of beta 2-adrenergic bronchodilators. The number of
beta 2 receptors increases within apx. 4 hours, and improved responsiveness to beta2 agonists
occurs within 2 hours.
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
You should have an understanding of all the key terms at the beginning of each chapter. Key learning objectives - answer the follow questions (frandsen chapter 33 - drug therapy for asthma and. Bronchoconstriction): the causes of asthma are unknown. When do people develop asthma: it appears to involve the relationship between host factors (genetic) and environmental exposures that occur at a critical time in immune system development. Nsaids: describe the relationship between asthma symptoms and gerd, asthma that worsens at night may be associated with night-time acid reflux. Although the mechanism of gerd in asthma i not known, experts suggest that microaspirations or a vagally mediated, reflex type of bronchoconstriction may be involved. Asthma, in turn, may also aggravate gerd< because anti-asthma medications that dilate the airways also relax muscle tone in gerd sphincter and may increase acid reflux. Airways mooth muscle extends from the trachea thru the bronchioles, and wraps around the airways in a spiral pattern.
