What etiologic factor is associated with the onset of nocturnal ...

[ts19998]

What etiologic factor is associated with the onset of nocturnal asthma?
 
  a. Aspiration of gastric acid at night
  b. Supine position
  c. Variation in acetylcholine secretion at night
  d. Variation in the secretion of insulin at night

Question 2

Which of the following strategies is useful in the mechanical ventilation of a patient in status asthmaticus?
 
  1. Allow peak inspiratory pressures to go as high as required.
  2. Permissive hypercapnia.
  3. Prolonged inspiratory time.
  4. Small tidal volumes.
  a. 1, 2, and 3 only
  b. 2 and 4 only
  c. 3 only
  d. 2, 3, and 4 only

[missalyssa26]

Answer to Question 1

ANS: A
It probably is due to the known physiologic decrease in the airway tone during sleep, which has been attributed to variation in catecholamine and cortisol secretion. Aspiration of gastric acid also may play a role in some patients with increased symptoms at night.

Answer to Question 2

ANS: B
Patients with severe asthma and respiratory failure (hypoxia, hypercapnia, and increased work of breathing) need ventilatory support and present special challenges. Mortality rates for these pa-tients can be as high as 22, and complications are common, especially barotrauma. These com-plications can be minimized by limiting peak inspiratory pressure to less than 50 cm H2O and by the use of small tidal volumes, allowing permissive hypercapnia if necessary.