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Questions and Answers
What is the primary function of the mucus barrier in the body?
What is the primary function of the mucus barrier in the body?
Mucoactive therapy is generally indicated for patients with which condition?
Mucoactive therapy is generally indicated for patients with which condition?
Which of the following mucoactive agents is approved for use in cystic fibrosis (CF) patients?
Which of the following mucoactive agents is approved for use in cystic fibrosis (CF) patients?
What is the primary effect of mucoactive agents on mucus?
What is the primary effect of mucoactive agents on mucus?
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What is the preferred term for medications that modify the physical properties of mucus?
What is the preferred term for medications that modify the physical properties of mucus?
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Which of the following diseases is NOT specifically mentioned as a condition where mucoactive therapy is indicated?
Which of the following diseases is NOT specifically mentioned as a condition where mucoactive therapy is indicated?
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What is the recommended nebulizer system for administering Dornase alfa?
What is the recommended nebulizer system for administering Dornase alfa?
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What is the primary purpose of using aqueous water or saline in mucoactive therapy?
What is the primary purpose of using aqueous water or saline in mucoactive therapy?
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Which of the following is NOT a key component of the mucociliary system?
Which of the following is NOT a key component of the mucociliary system?
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What is the primary function of the mucus layer in the airway?
What is the primary function of the mucus layer in the airway?
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Which of the following factors can decrease mucociliary transport velocity?
Which of the following factors can decrease mucociliary transport velocity?
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What is a key characteristic of mucus secretion in a healthy individual?
What is a key characteristic of mucus secretion in a healthy individual?
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In which of the following conditions is mucus hypersecretion a common feature?
In which of the following conditions is mucus hypersecretion a common feature?
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What is the primary characteristic difference between the airway secretions in cystic fibrosis and those in other respiratory conditions?
What is the primary characteristic difference between the airway secretions in cystic fibrosis and those in other respiratory conditions?
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What is the primary mechanism of action for N-acetylcysteine (NAC) in modifying airway secretions?
What is the primary mechanism of action for N-acetylcysteine (NAC) in modifying airway secretions?
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Which of the following agents is specifically used to break down DNA in thick, viscous mucus?
Which of the following agents is specifically used to break down DNA in thick, viscous mucus?
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Which of the following statements is TRUE about the role of hypertonic saline in modifying airway secretions?
Which of the following statements is TRUE about the role of hypertonic saline in modifying airway secretions?
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In the context of airway secretions, what does the term "mucoactive" refer to?
In the context of airway secretions, what does the term "mucoactive" refer to?
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Based on the information provided, which of the following is a common misconception about the use of mucoactive agents?
Based on the information provided, which of the following is a common misconception about the use of mucoactive agents?
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Which of the following cell types is primarily responsible for mucus production in the airway?
Which of the following cell types is primarily responsible for mucus production in the airway?
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What is the main mechanism by which cilia move mucus in the airway?
What is the main mechanism by which cilia move mucus in the airway?
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In the context of airway secretions, what is the difference between "phlegm" and "sputum"?
In the context of airway secretions, what is the difference between "phlegm" and "sputum"?
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Which factor is directly related to the increased mucus production during an asthma attack?
Which factor is directly related to the increased mucus production during an asthma attack?
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According to the information provided, which of the following does NOT lead to a decrease in mucociliary transport velocity?
According to the information provided, which of the following does NOT lead to a decrease in mucociliary transport velocity?
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Which of the following medications is NOT considered a mucolytic agent?
Which of the following medications is NOT considered a mucolytic agent?
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Which of the following is a true statement about the mechanism of action of Dornase alfa?
Which of the following is a true statement about the mechanism of action of Dornase alfa?
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Which of the following is a primary indication for dornase alfa?
Which of the following is a primary indication for dornase alfa?
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Which of the following is NOT a common side effect associated with inhaled anticholinergics?
Which of the following is NOT a common side effect associated with inhaled anticholinergics?
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Which of the following techniques aims to increase airflow to move secretions without forced exhalation?
Which of the following techniques aims to increase airflow to move secretions without forced exhalation?
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What is the usual dosage of Dornase alfa administered via aerosol?
What is the usual dosage of Dornase alfa administered via aerosol?
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Which of the following statements accurately describes the role of surfactant in the airways?
Which of the following statements accurately describes the role of surfactant in the airways?
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Which of the following is a mucoregulatory medication that does NOT directly affect mucus viscosity?
Which of the following is a mucoregulatory medication that does NOT directly affect mucus viscosity?
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Which of the following is NOT a technique commonly employed for airway clearance?
Which of the following is NOT a technique commonly employed for airway clearance?
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Which of the following statements best describes the benefit of pursed-lip breathing?
Which of the following statements best describes the benefit of pursed-lip breathing?
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What is the primary application of an insufflation-exsufflation device?
What is the primary application of an insufflation-exsufflation device?
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Which of the following medications is primarily used to decrease the inflammatory stimulus that leads to mucus hypersecretion?
Which of the following medications is primarily used to decrease the inflammatory stimulus that leads to mucus hypersecretion?
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Which of the following agents is NOT used for the treatment of abnormal pulmonary secretions?
Which of the following agents is NOT used for the treatment of abnormal pulmonary secretions?
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Which of the following techniques combines PEP with high-frequency oscillations at the airway opening?
Which of the following techniques combines PEP with high-frequency oscillations at the airway opening?
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Which of the following statements accurately describes the mechanism of action of hypertonic saline?
Which of the following statements accurately describes the mechanism of action of hypertonic saline?
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Which of the following statements is true regarding the use of exercise for airway clearance?
Which of the following statements is true regarding the use of exercise for airway clearance?
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Flashcards
Mucoactive Therapy
Mucoactive Therapy
Treatment aimed at reducing airway secretions to improve lung function.
Mucus Functions
Mucus Functions
Mucus protects, lubricates, and waterproofs airways, preventing infections.
Mucolytic Agent
Mucolytic Agent
Drugs aimed at thinning mucus; better referred to as mucoactive agents.
Chronic Bronchitis
Chronic Bronchitis
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Cystic Fibrosis
Cystic Fibrosis
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Dornase Alfa
Dornase Alfa
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Hyperosmolar Saline
Hyperosmolar Saline
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Indications for Mucoactive Therapy
Indications for Mucoactive Therapy
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Mucociliary System
Mucociliary System
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Mucus Composition
Mucus Composition
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Airway Secretions
Airway Secretions
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Goblet Cells
Goblet Cells
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Ciliary Movement
Ciliary Movement
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Asthma Symptoms
Asthma Symptoms
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Factors Affecting Mucociliary Transport
Factors Affecting Mucociliary Transport
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Mucin Glycoproteins
Mucin Glycoproteins
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Airway Secretions in Disease
Airway Secretions in Disease
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Submucosal Glands
Submucosal Glands
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Diet and Mucus Production
Diet and Mucus Production
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Mucoactive Agents
Mucoactive Agents
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N-acetylcysteine (NAC)
N-acetylcysteine (NAC)
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7% hypertonic saline
7% hypertonic saline
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Aerosol delivery
Aerosol delivery
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Mucokinetic agents
Mucokinetic agents
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Surfactants
Surfactants
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Anticholinergics
Anticholinergics
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Corticosteroids
Corticosteroids
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Autogenic Drainage (AD)
Autogenic Drainage (AD)
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Insufflation-Exsufflation
Insufflation-Exsufflation
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Pursed-lip breathing
Pursed-lip breathing
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Flutter device
Flutter device
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Chest wall compression
Chest wall compression
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Study Notes
Mucoactive Therapy for Mucus Disorders
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Mucoactive therapy is considered after treatments to reduce infection and inflammation. Mucus has protective, lubricating, and waterproofing properties. It protects against osmotic and inflammatory changes, entrapping microorganisms to inhibit infection and biofilm formation.
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Mucus is a viscoelastic gel. Mucolytic agents (better termed mucoactive agents) should affect mucus gel properties to improve cough or mucociliary clearance. Thinning secretions, or mucolysis, can decrease clearance.
Clinical Indications for Mucoactive Therapy
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The goal is to reduce airway secretions, improving lung function, gas exchange, and preventing infections and damage.
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Diseases needing mucoactive therapy include chronic bronchitis, cystic fibrosis, diffuse panbronchiolitis, asthma, and bronchiectasis. However, patients with strong coughs and expiratory airflow usually respond better.
Mucoactive Agents for Aerosol Administration
- N-acetylcysteine (NAC): Efficacy for any lung disease with any dose hasn't been demonstrated.
- Dornase alfa (Pulmozyme): For cystic fibrosis (CF) only, used to clear purulent secretions.
- Aqueous Water/Saline: For sputum induction.
- Hyperosmolar Saline (7%): Used for CF airway clearance.
- Dry Powder Mannitol: For CF airway clearance.
- 3% Hyperosmolar Saline: For infantile bronchiolitis.
Physiology of the Mucociliary System
- Airway lining is the mucociliary system, with a gel layer of mucus propelled by cilia atop a periciliary layer.
- Cells responsible for secretion include surface epithelial cells (ciliated and goblet cells, club cells), and submucosal glands.
- Submucosal glands produce mucus in cartilaginous airways.
- Mucus protects the respiratory tract, humidifying and warming inspired gas, transporting debris, waterproofing, and acting antibacterially.
Terminology: Mucus, Phlegm, Sputum
- Confusion exists regarding classifying mucoactive medications.
Factors Affecting Mucociliary Transport
- Transport is about 1.5 mm/min in peripheral airways and 20 mm/min in the trachea. Transport is reduced by:
- COPD and CF
- Airway drying
- Narcotics
- Endotracheal suctioning, trauma, tracheostomy
- Tobacco smoke, pollutants, allergens (can initially increase transport at low concentrations, but decrease at high concentrations or with prolonged exposure).
- Hyperoxia and hypoxia
Nature of Mucus Secretion
- A healthy person produces about 100 mL of mucus daily. Normal mucus is clear, viscoelastic, and sticky.
Structure and Composition of Mucus
- Mucins are major macromolecular components of mucus gel. They determine protective and clearance properties.
Secretions in Disease States
- Chronic Bronchitis (CB): Characterized by daily sputum expectoration for 3 months a year for 2 consecutive years, typically in smokers or ex-smokers. Hyperplasia of submucosal glands and goblet cells in the airways.
- Asthma: Can include mucus hypersecretion during acute episodes or as a chronic feature with airway inflammation. Sputum expectoration can increase in 80% of patients.
- Cystic Fibrosis (CF): Hereditary disease with impaired CFTR protein function. Chronic airway infection (often Pseudomonas and other gram-negatives) and inflammation lead to bronchiectasis, and ultimately death. Airways are filled with pus instead of mucus in established CF bronchiectasis.
Dornase Alfa (Pulmozyme)
- Indicated only for clearing purulent secretions in CF.
- Breaks down extracellular DNA.
- Reduces viscosity and adhesiveness of infected respiratory secretions.
- Safe and effective in severe pulmonary disease (FVC < 40% predicted).
Mucokinetic Agents
- Include inhaled anticholinergics (e.g., atropine), tricyclic nucleotides, phospholipids, antiproteases, and gene therapy.
- Increase cough clearance by increasing expiratory airflow or reducing sputum adhesiveness.
Surface-Active Phospholipids
- Produced in airways and alveoli.
- Important for mucociliary and cough clearance.
- Create a surfactant sheet that prevents dehydration, allows for proper spreading of mucus, and enables proper ciliary coupling and release.
Mucoregulatory Medications
- Include anti-inflammatory drugs (e.g., corticosteroids) effective reducing inflammatory mucus hypersecretion.
- Atropine decreases mucus secretion associated with intubation, but does not dry or increase viscosity.
- Quaternary ammonium derivatives (ipratropium bromide, tiotropium) avoid systemic anticholinergic effects.
Hyperosmolar Saline and Mannitol
- Hypertonic saline (7%) improves mucociliary transport and lung function. Likely from inducing cough and hydrating airway surface fluid.
Insufflation–Exsufflation; Cough Assist, Autogenic Drainage, Exercise, Positive Airway Pressure, Pursed-Lip Breathing, Oscillatory Positive Expiratory Pressure, Chest Wall Compression
- Techniques used to assist mucus clearance. Methods include insufflation/exsufflation, autogenic drainage, exercise, pursed-lip breathing, and devices such as Flutter and vests. These help increase expiratory airflow and reduce sputum adhesiveness.
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Description
Explore the essential concepts of mucoactive therapy in managing mucus disorders. This quiz covers the properties of mucus, the indications for mucoactive therapy, and specific agents used for aerosol administration. Learn about diseases that require this therapy and how it improves lung function.