Asthma Book Flashcards
is a heterogeneous disease, usually characterized by chronic airway inflammation
Asthma
This chronic inflammatory disease of the airways causes
airway hyperresponsiveness
mucosal edema
mucus production
This inflammation ultimately leads to recurrent episodes of asthma symptoms
cough, chest tightness, wheezing, and dyspnea
is the most common chronic disease of childhood, it can occur at any age.
Asthma
disruptive disease, affecting school and work attendance, occupational choices, physical activity, and general quality of life.
Asthma
Predisposing factors
Atopy
Female gender
Casual factors
Exposure to indoor and outdoor allergens
Occupational sensitizer
Contributing factors
Respi infection
Air pollution
Active/passive smoking
Diet
Microsomia
Factors causes
Inflammation
Inflammation causes
Hyper responsiveness of airways
Airflow limitations
Symptoms
Risk factors for exacerbations
Allergens
Respiratory infections
Exercise and hyperventilation
Weather changes
Exposure to sulfur dioxide
Exposure to food, additives, meds
percent of patients with asthma smoke, even though cigarette smoke is known to trigger an attack
21 percent
Percent of people without asthma smoke
17%
refers to patients who have clinical presentations of both conditions
Asthma-COPD
are at higher risk for having asthma–COPD overlap
Smokers
Contributing to these disparities are epidemiologic considerations and risk factors that include
genetic and molecular aspects;
inner-city environments;
limited community assets;
health care access/delivery/and quality;
and insufficient health insurance
coverage
Unlike other obstructive lung diseases, asthma is
Largely reversible, spontaneous or tx
is the strongest predisposing factor for asthma
Allergy
Common allergens
Seasonal or Perennial
Seasonal allergens
grass, tree, weed pollens
Perennial allergens
mold, dust, roaches, animal dander
Common triggers for asthma symptoms and exacerbations
Airway irritants
Foods
exercise, stress, hormonal factors, medications, viral respiratory tract infections, and gastroesophageal refl
is reversible diffuse airway inflammation that leads to long-term airway narrowing.
Asthma
This narrowing, which is exacerbated by various changes in the airway, includes
bronchoconstriction, airway edema, airway hyperresponsiveness, and airway remodeling
all play a key role in the inflammation of asthma
Mast cells, macrophages, T lymphocytes, neutrophils, and eosinophils
When activated, mast cells release several chemicals called
Mediators
chemicals and other mediators, perpetuate the inflammatory response
histamine, bradykinin, prostanoids, cytokines, leukotrienes,
Chemicals and mediators causes
increased blood flow, vasoconstriction, fluid leak from the vasculature, attraction of white blood cells to the area, mucus secretion, and bronchoconstriction
bronchial smooth muscle contraction
or bronchoconstriction occurs quickly to narrow the airway in response to an exposure.
Acute exacerbation of asthma
Acute bronchoconstriction due to allergens results from an
immunoglobulin E (IgE)-dependent release of mediators from mast cells
IgE mediators that contract the airway
histamine, tryptase, leukotrienes, and prostaglandins
are stimulated, bronchoconstriction occurs
alpha-adrenergic receptors
The balance between alpha- and beta-2–adrenergic receptors is controlled primarily
cyclic 3′,5′-adenosine monophosphate (cyclic AMP
results in increased levels of cyclic AMP, which inhibits the release of chemical mediators and causes bronchodilation
Beta-2–adrenergic stimulation
The three most common symptoms of asthma are
Cough, dyspnea, and wheezing
Asthma attack occurs
At night or early in the morning
As the exacerbation progresses these occur
diaphoresis, tachycardia, and a widened pulse pressure c hypoxemia and central cyanosis (late sign of poor oxygen)
is secondary to a ventilation–perfusion mismatch and readily responds to supplemental oxygenation.
Hypoxemia
Symptoms of exercise-induced asthma include
Maximal symptoms during exercise
Absence of nocturnal symptoms
Choking sensation during exercise
Assessment and dx findings
Family hx
Sputum and bld tests (eosinophilia)
Serum levels of IgE increase
ABG and pulse oximetry (Hypoxemia)
FEV1 and FVC
Pulmonary fx
Initially these are prsent, then if condition worsen… May increase
Hypocapnia and respi alka… Increase PaCO2
Prevention
Undergo testing to identify what precipitate sx
refers to asthma induced by exposure in the work environment to dusts, vapors, or fumes, with or without a preexisting diagnosis of asthma.
Occupational asthma
should be part of the differential diagnosis of every case of adult-onset asthma
Work-related asthma
Complications
status asthmaticus, respiratory failure, pneumonia, and atelectasis
particularly during acute asthmatic episodes, often results in hypoxemia, requiring the administration of oxygen and the monitoring of pulse oximetry and arterial blood gases
Airway obstruction
Medical mgt
Pharmacologic Therapy
Mgt of exacerbations
Peak flow monitoring
Primary tx
Primary tx: preventing impairment of lung function, minimizing symptoms, and preventing exacerbations
immediate interventioncto diminish bronchoconstriction
Pharmacologic Therapy
Two general classes of asthma meds: quick-relief medications & longacting medications
for immediate treatment of asthma symptoms and exacerbations.
quick-relief medications
to achieve and maintain control of persistent asthma
longacting medications
Because the underlying pathology of asthma is inflammation, control of persistent asthma is accomplished primarily with regular use of
anti-inflammatory medications
The route of choice for administration of these medications which allows for localized administration within the lungs
pMDI
Quick-Relief Medications
Short-acting beta-2–adrenergic
agonists (SABAs)
Anticholinergics
relief of acute symptoms and prevention of exercise-induced asthma. They are used to relax smooth muscle.
Short-acting beta-2–adrenergic
agonists (SABAs)
inhibit muscarinic cholinergic receptors
and reduce intrinsic vagal tone of the airway
Anticholinergics
Long-Acting Control Medications
Corticosteroids
Long-acting beta-2 adrenergic agonists (LABAs)
Leukotriene modifiers (inhibitors), or antileukotrienes
are the most potent and effective anti-inflammatory medications currently available.
Corticosteroids
are used with antiinflammatory medications to control asthma symptoms, particularly those that occur during the night.
Long-acting beta-2 adrenergic agonists (LABAs)
are a class of medications that include montelukast, zafirlukast, and zileuton. Dilate BV
Antileukotrienes
Mgt of exacerbations
early treatment and education
ICS tx
Short-acting beta-2–adrenergic agonist medications
Systemic corticosteroids
oxygen supplementation
ICS-LABA
measure the highest airflow during a forced expiration
Peak flow meters
Daily peak flow monitoring is recommended for patients who meet one or more of the following criteria
have moderate or severe persistent asthma, have poor perception of changes in airflow or worsening symptoms, have unexplained response to environmental or occupational exposures, or at the discretion of the clinician and patient
helps measure asthma severity and, when added to symptom monitoring, indicates the current degree of asthma control.
Peak flow monitoring
peak flows are monitored for..after receipt of optimal asthma therapy.
2-3 weeks
Green
80% to 100% of personal best
yellow
60% to 80%
Nsg mgt
assesses the patient’s respiratory status by monitoring the severity of symptoms, breath sounds, peak flow, pulse oximetry, and vital signs.
The nurse generally performs the following interventions:
Obtains a history of allergic reactions to medications before administering medications.
Identifies medications the patient is taking.
Administers medications as prescribed and monitors the patient’s responses to those medications.
These medications may include an antibiotic if the patient has an underlying respiratory infection.
Administers fluids if the patient is dehydrated
