Respiratory Pathologies

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Respiratory Pathologies
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Asthma -Pathophysiology

• Airway hyper-responsiveness reactivity
  (bronchospasm)
• Airway inflammation
• Response to a variety of triggers

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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.

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Asthma Mechanism of Wheezing

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

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Asthma - Diagnosis

• S/S
• Exposure to trigger
• Family Hx
• Pulmonary Function Tests
• Response to Tx

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Asthma Common Triggers

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

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Exercise-Induced Bronchospasm

• Exercise induced asthma
• Symptoms ONLY seen with exercise
• Occurs when?

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Exercise Induced Brochospasm

• Two Theories
• A. Water-lose Theory
• B. Heat-exchange Theory

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EIA

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

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EIA

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

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Peak Flow Meters

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

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Formal PFTs

• Pulmonary Function Tests
• Computerized
• Graph Data

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Asthma - Treatment

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

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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!

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Dry Powder Inhalers

• Inhalation of powder med
• May work just as well as MDI
• Advantages
• Disadvantages

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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

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Salmeterol

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

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Cromolyn

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

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Leukotriene Modifiers

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

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Inhaled Corticosteroids

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

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Multimodal Therapy

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

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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

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ALL That Coughs is not Asthma

• Differential Diagnosis

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Other options

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

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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

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GERD

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

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Upper Respiratory Infection

• The common cold
• s/s
• Tx
• Modify activity based on energy level.

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Exercised-induced anaphylaxis

• Rare literally allergic to exercise!
• Triggered by exercise
• s/s
• Tx

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Pneumonia

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

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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
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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