Mucoactive Therapy for Mucus Disorders
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Questions and Answers

What is the primary function of the mucus barrier in the body?

  • To facilitate the growth of microorganisms
  • To protect against infections and inflammation (correct)
  • To decrease the absorption of nutrients
  • To increase the viscosity of secretions
  • Mucoactive therapy is generally indicated for patients with which condition?

  • Increased mucus production or impaired clearance of airway secretions (correct)
  • Viral infections
  • Chronic constipation
  • Decreased mucus production
  • Which of the following mucoactive agents is approved for use in cystic fibrosis (CF) patients?

  • Dornase alfa (correct)
  • Hyperosmolar 7% saline
  • Aqueous water, saline
  • N-acetylcysteine (NAC)
  • What is the primary effect of mucoactive agents on mucus?

    <p>Decreased viscosity (A)</p> Signup and view all the answers

    What is the preferred term for medications that modify the physical properties of mucus?

    <p>Mucoactive agents (C)</p> Signup and view all the answers

    Which of the following diseases is NOT specifically mentioned as a condition where mucoactive therapy is indicated?

    <p>Pneumonia (D)</p> Signup and view all the answers

    What is the recommended nebulizer system for administering Dornase alfa?

    <p>Small volume nebulizer (SVN) (A)</p> Signup and view all the answers

    What is the primary purpose of using aqueous water or saline in mucoactive therapy?

    <p>To induce sputum production (C)</p> Signup and view all the answers

    Which of the following is NOT a key component of the mucociliary system?

    <p>Bone marrow cells (A)</p> Signup and view all the answers

    What is the primary function of the mucus layer in the airway?

    <p>To trap and remove foreign particles (C)</p> Signup and view all the answers

    Which of the following factors can decrease mucociliary transport velocity?

    <p>Use of dry gas for mechanical ventilation (B), Cigarette smoking (C)</p> Signup and view all the answers

    What is a key characteristic of mucus secretion in a healthy individual?

    <p>Clear color and sticky consistency (B)</p> Signup and view all the answers

    In which of the following conditions is mucus hypersecretion a common feature?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the primary characteristic difference between the airway secretions in cystic fibrosis and those in other respiratory conditions?

    <p>Cystic fibrosis secretions contain very little intact mucin (C)</p> Signup and view all the answers

    What is the primary mechanism of action for N-acetylcysteine (NAC) in modifying airway secretions?

    <p>Breaking down the bonds in thick mucus (D)</p> Signup and view all the answers

    Which of the following agents is specifically used to break down DNA in thick, viscous mucus?

    <p>Dornase alfa (C)</p> Signup and view all the answers

    Which of the following statements is TRUE about the role of hypertonic saline in modifying airway secretions?

    <p>It draws water into the airway lumen, making the secretions thinner (D)</p> Signup and view all the answers

    In the context of airway secretions, what does the term "mucoactive" refer to?

    <p>Agents that change the properties of mucus (A)</p> Signup and view all the answers

    Based on the information provided, which of the following is a common misconception about the use of mucoactive agents?

    <p>All mucoactive agents work by thinning the mucus (B)</p> Signup and view all the answers

    Which of the following cell types is primarily responsible for mucus production in the airway?

    <p>Goblet cells (A), Submucosal gland cells (B)</p> Signup and view all the answers

    What is the main mechanism by which cilia move mucus in the airway?

    <p>Movement of the ciliary beat (A)</p> Signup and view all the answers

    In the context of airway secretions, what is the difference between "phlegm" and "sputum"?

    <p>Sputum is mucus that has been expelled during coughing, while phlegm is mucus that remains in the respiratory system (C)</p> Signup and view all the answers

    Which factor is directly related to the increased mucus production during an asthma attack?

    <p>Hyperplasia of goblet cells (D)</p> Signup and view all the answers

    According to the information provided, which of the following does NOT lead to a decrease in mucociliary transport velocity?

    <p>Hyperoxia (A)</p> Signup and view all the answers

    Which of the following medications is NOT considered a mucolytic agent?

    <p>Ipratropium bromide (C)</p> Signup and view all the answers

    Which of the following is a true statement about the mechanism of action of Dornase alfa?

    <p>It breaks down extracellular DNA in airway secretions. (B)</p> Signup and view all the answers

    Which of the following is a primary indication for dornase alfa?

    <p>Cystic fibrosis (CF) (A)</p> Signup and view all the answers

    Which of the following is NOT a common side effect associated with inhaled anticholinergics?

    <p>Increased mucus production (B)</p> Signup and view all the answers

    Which of the following techniques aims to increase airflow to move secretions without forced exhalation?

    <p>Autogenic drainage (D)</p> Signup and view all the answers

    What is the usual dosage of Dornase alfa administered via aerosol?

    <p>2.5 mg daily (B)</p> Signup and view all the answers

    Which of the following statements accurately describes the role of surfactant in the airways?

    <p>Surfactant is important for mucociliary and cough clearance. (B)</p> Signup and view all the answers

    Which of the following is a mucoregulatory medication that does NOT directly affect mucus viscosity?

    <p>Atropine (C)</p> Signup and view all the answers

    Which of the following is NOT a technique commonly employed for airway clearance?

    <p>Gene therapy (C)</p> Signup and view all the answers

    Which of the following statements best describes the benefit of pursed-lip breathing?

    <p>It helps to relieve air trapping caused by airway collapse during expiration. (D)</p> Signup and view all the answers

    What is the primary application of an insufflation-exsufflation device?

    <p>Assisting patients with muscular weakness who cannot cough effectively. (D)</p> Signup and view all the answers

    Which of the following medications is primarily used to decrease the inflammatory stimulus that leads to mucus hypersecretion?

    <p>Corticosteroids (B)</p> Signup and view all the answers

    Which of the following agents is NOT used for the treatment of abnormal pulmonary secretions?

    <p>Atropine (A)</p> Signup and view all the answers

    Which of the following techniques combines PEP with high-frequency oscillations at the airway opening?

    <p>Flutter mucus clearance device (A)</p> Signup and view all the answers

    Which of the following statements accurately describes the mechanism of action of hypertonic saline?

    <p>It improves mucociliary transport and lung function by hydrating airway surface fluid. (C)</p> Signup and view all the answers

    Which of the following statements is true regarding the use of exercise for airway clearance?

    <p>Exercise may augment bronchial hygiene and should be encouraged. (B)</p> Signup and view all the answers

    Flashcards

    Mucoactive Therapy

    Treatment aimed at reducing airway secretions to improve lung function.

    Mucus Functions

    Mucus protects, lubricates, and waterproofs airways, preventing infections.

    Mucolytic Agent

    Drugs aimed at thinning mucus; better referred to as mucoactive agents.

    Chronic Bronchitis

    A respiratory disease characterized by excessive mucus production and poor airway clearance.

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    Cystic Fibrosis

    A genetic disorder causing severe lung damage and mucus buildup, requiring mucoactive therapy.

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    Dornase Alfa

    A mucoactive agent specifically used for treating cystic fibrosis via nebulization.

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    Hyperosmolar Saline

    A mucoactive therapy used to improve airway clearance through increased moisture.

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    Indications for Mucoactive Therapy

    Conditions like chronic bronchitis and asthma where mucus clearance is impaired.

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    Mucociliary System

    The system in the airway that moves mucus and debris using cilia.

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    Mucus Composition

    Mucus consists mainly of mucin glycoproteins, providing protection and clearance.

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    Airway Secretions

    Fluid secreted in the airways, consisting largely of mucus that traps debris.

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    Goblet Cells

    Cells in the airway lining that produce mucus, increasing in number during inflammation.

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    Ciliary Movement

    The action of cilia that transports mucus out of the airways.

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    Asthma Symptoms

    Increased mucus production can occur during asthma symptoms or attacks.

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    Factors Affecting Mucociliary Transport

    Conditions like COPD, smoking, and pollutants slow mucus movement in airways.

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    Mucin Glycoproteins

    Large macromolecules that make up the gel structure of mucus in healthy individuals.

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    Airway Secretions in Disease

    Different diseases can alter the properties and types of secretions in the airway.

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    Submucosal Glands

    Glands in the airways that produce mucus, primarily in cartilaginous areas.

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    Diet and Mucus Production

    No significant link between milk consumption and increased mucus production in airways.

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    Mucoactive Agents

    Drugs that modify airway secretions, like N-acetylcysteine and dornase alfa.

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    N-acetylcysteine (NAC)

    A mucolytic drug disrupting disulfide bonds in mucus.

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    7% hypertonic saline

    Aerosol recommended for treating cystic fibrosis.

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    Aerosol delivery

    Method of administering medication as a mist for inhalation.

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    Mucokinetic agents

    Substances that enhance airway secretion clearance.

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    Surfactants

    Substances reducing surface tension in airways to aid clearance.

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    Anticholinergics

    Medications that reduce mucus secretion and spasm.

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    Corticosteroids

    Anti-inflammatory drugs reducing mucus hypersecretion.

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    Autogenic Drainage (AD)

    Technique to clear mucus through controlled breathing.

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    Insufflation-Exsufflation

    Device simulating a cough by alternating pressure.

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    Pursed-lip breathing

    Technique to relieve trapped air in lungs during exhalation.

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    Flutter device

    Combines positive expiratory pressure with oscillations.

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    Chest wall compression

    Mechanical device providing vibrations to aid clearance.

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    Study Notes

    Mucoactive Therapy for Mucus Disorders

    • 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.

    • 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

    • The goal is to reduce airway secretions, improving lung function, gas exchange, and preventing infections and damage.

    • 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.

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