Asthma Flashcards
Triggers/Risk Factors for Asthma
- Genetic
- Exposure to certain infections early in life
- Exposure to air pollutants
- Obesity
- Maternal smoking
- Premature birth
- exercise
- emotional upsest
- Resp. tract infection
- ASA or Nsaids
- cold or hot air
Women at 30 yo?
- pregnant?
- asthma is the most common resp problem while pregnant
- low birth weights, hyper emesis, etc..
- Asthma is usually dormant during L&D
Goals of Tx for pregnant asthmatic?
-prevent from worsening
CC and main causes
chronic cough
main causes:
- asthma (inflammation)
- Postnasal drip (PND)
- GERD
- Smoking
- Chronic bronchitis
- Medication induced
- Post-respiratory infection
Asthma
chronic inflammatory disease characterized by reoccurring episodes of wheezing, breathlessness, chest tightness, and coughing
Class of meds that cause cough
-Ace inhibitors
Focused exam for Asthma related symptoms
- Resp/Perfusion
- Cardio/Perfusion
- Skin (rashes, allergies, etc..)
- Abdomen (GERD, etc..)
Peak Flow Meter
- PEFR
- measures what force they can exhale
- Allows patients to monitor symptoms and communicate severity to others
- Patients need to establish “personal best” or their “normal” PEFR
- personal best/normal is used to evaluate severity of airway obstruction
Spirometry
- breathe in as much as possible and it measures how much is exhaled.
- thorough assessment of lung function
- often done before and after medication given
- generally used in diagnosis
Other Diagnostic Tests
- CBC with differential
- ABG
- CXR
- Oxygen saturation
- Transcutaneous O2 and CO2 monitoring
Other Diagnostic Tests
- CBC with differential
- ABG
- CXR
- Oxygen saturation
- Transcutaneous O2 and CO2 monitoring
Pharmacologic Therapy Goals
- prevent and control symptoms
- reduce frequency and severity of exacerbations
- reverse airway obstruction
Effects adrenergic drugs can have on the body
- increasing BP
- constricting blood vessels
- opening the airways leading to the lungs**
- increasing HR
- Stopping bleeding
Bronchodilators: Beta 2 agonists can be…
short acting and long-acting
Bronchodilators: Anticholinergics
-useful when asthma symptoms are poorly controlled by adrenergic stimulants alone
Atropine
Bronchodilators: Anticholinergics
Ipratropium bromide
Bronchodilators: Anticholinergics
Atrovent
Tiotopium bromide
Bronchodilators: Anticholinergics
Spiriva
Albuterol/Ipratropium
Bronchodilators: Anticholinergics
combo drug
Combivent
Pharmacologic Focus of Tx
- Quick relief (short term) therapy
- Long term therapy (stable asthma)
early life asthma….
leads to irreversible decline in pulmonary function in adulthood due to airway remodeling
airway remodeling
permanent, structural changes
can progress to permanent loss of lung fx
airway narrowing leads to…
- limits airflow
- increase work of breathing
- trapped air mixes with inhaled air, impairing gas exchange
Acute Asthma Attack
- inflammatory mediators released from sensitized airways, causing activation of inflammatory cells that leads to:
1. bronchoconstriction
2. airway edema
3. impaired mucocilary clearance
Priority nursing action upon exacerbation
- maintain oxygenation
2. maintain patent airway
Corticosteroids Side Effects given orally for short-term therapy
- typically resolves after therapy stops
- glaucoma (elevated pressure in eyes)
- fluid retention, which causes swelling in lower legs
- HTN
- mood swings
- weight gain (fat deposits in the abdomen, face, and the back of the neck)
Corticosteroids Side Effects given orally for long-term therapy
- cataracts
- hyperglycemia
- increased risk of infections
- osteoporosis
- increased risk of fractures
- suppression of adrenal gland hormone production
- bruising, thin skin
- delayed wound healing
- growth suppression in children
Corticosteroids Side Effects for inhaled/nebulized corticosteroids
- oral thrush
- hoarseness
- can be easily avoided by rinsing and gurgling with water following medication administered
MDI Inhaler
- firmly insert a charged MDI canister into the mouthpiece unit or spacer
- Remove mouthpiece cap. Shake canister vigorously for 3-5 seconds
- exhale slowly and completely
- holding the canister upside down, place the mouthpiece in the mouth, closing lips around it if a space is being used. When no spacer is being used, hold the mouthpiece directly in front of mouth
- press and hold canister down while inhaling deeply and slowly for 3-5 seconds
- hold breath for 10 seconds, release pressure on the container, remove from mouth and exhale. Wait20-30 seconds before repeating the procedure for a second puff
- rinse mouth after using the inhaler to minimize systemic absorption and drying the mucous membrane
- Rinse the inhaler mouthpiece and spacer after use, store in clean location
Corticosteroids
block the late response to inhaled allergens and reduce edema and bronchial hyperresponsiveness.
-preferred route is MDI or DPI to minimize systemic absorption and reduce the many ADRs of prolonged steroid use.
Pulmonary Tests help…
- confirm diagnosis
- rule out complications
- evaluate severity of condition
- Calculate amount and rate of air expelled during a single breath
- patient’s info is plotted on continuum, allowing comparison to average breathing patterns for healthy individuals of the same age, sex, and size
Beta 2 Agonists
- affect sympathetic receptors of the resp track
- causes relaxation and bronchodilation of the smooth muscle of respiratory track
Bronchodilators: Anticholinergics
- Requires as much as 60-90 mins to achieve max effect
- usually admin via MDI/DPI
Rescue inhalers/meds
SABAs
- albuterol
- bitolterol
- pributerol
- terbutaline
admin MDI/DPI
4-6 hrs duration
Methylxanthine
Bronchodilator
- may also affect inflammatory response
- used as ADJUNCT treatment
- Theophylline and Aminophylline
- used primarily to prevent nocturnal asthma in adults
- narrow margin of safety and high potential for toxicity
**no smoking!!!!
Quick Relief Meds
- SABAs
- Anticholinergics
- Methyxanthines
Long-term Control Meds
- Short and long-acting bronchodilators
- Anti-inflammatory agents
- Leukotriene modifiers
SABA
- recommended for quick relief
- up to 3 tx at 20 min intervals OR a single nebulizer tx
When is it advised to step up therapy…
use of a SABA >2 days/week which indicates inadequate control
If taking bronchodilator and another medication via inhalation….
use bronchodilator first
Differences between MDI and DPI
- MDI not in mouth, DPI in mouth
- MDI is solution/suspension and DPI solid particles
- MDI contains surfactants and lubricants and DPI might contain lactose
- MDI requires coordination and DPI patient controls inhalations
- MDI rinse after each use and DPI clean weekly with dry cloth
Spacers
- improve coordination between delivery of medication from inhaler and breathing it into the bronchial tubes
- reduce the amount of medication that settles in mouth and throat
Stepwise approach
used for treatment:
- prevent asthma symptoms
- provide best therapy for pt
- may be some differences in each healthcare providers “step” approach
Step 1 through Step 4
1: mild intermittent. No daily med. systemic corticosteroids for severe exacerbations
2: mild persistent. low-dose inhaled corticosteroids. cromolyn, leukotriene modifier, nedocromil,or sustained-released theophylline
3: low to mod dose inhaled corticosteroids AND long acting inhaled B2 agonist
4: high dose inhaled corticosteroids and long acting inhaled B2 agonist
