Chap 13- Asthma Flashcards
Asthma educator
therapists goal is to be sure that the pts and the family are cognizant of their role and functions in the care of this usually chronic and often serious condition. Serve as a “change agent”
Today guidelines are structured around the following four components of care
- assessment and monitoring of asthma 2. Patient education 3. control of factors contributing to asthma severity 4. pharmacologic treatments
NAEPP guidelines include
six steps of asthma management based upon degree of asthma control,
four levels of asthma; intermittent and 3 levels of persistent: mild, moderate, severe.
Adjustment to management based upon asthma control,
Use of actions plans for children and adults are recommended
GINA
Global Initiative for asthma. Gathers and disseminates asthma related info while also ensuring that a system is in place to incorporate the results of scientific investigations into asthma care
GINA’s specific goals
Increase awareness of asthma and its public health consequences,
Promote identification of reasons for the increased prevalence of asthma,
Promote study of the association between asthma and the environment,
Reduce asthma morbidity and mortality,
Improve management of asthma,
Improve availability and accessibility of effective asthma therapy
Asthma is described as a lung disorder characterized by
- Reversible bronchial smooth muscle constriction, 2. Airway inflammation, 3. Increased airway responsiveness to an assortment of stimuli
During an asthma attack the smooth muscles surrounding the small airways…
constrict… over time the smooth muscle layers hypertrophy and can increase to three times their normal thickness
In asthma the airway mucosa becomes infiltrated with… and in turn…
eosinophils and other inflammatory cells, which in turn causes airway inflammation and mucosal edema.
Microscopic crystals
Charcot-Leyden crystals
Charcot-Leyden crystals are formed
from breakdown of eosinophils in pts with allergic asthma. May be as large as 50um in length
The goblet cells… and the bronchial mucous glands….
Goblet cells proliferate and the bronchial mucous glands enlarge. The airways become filled with thick, whitish, tenacious mucus.
When airways become filled with thick, whitish, tenacious mucous
Extensive mucous plugging and atelectasis may develop
As a result of smooth muscle constriction, bronchial mucosal edema, and excessive bronchial secretions,
airtrapping and alveolar hyperinflation develop
Chronic inflammation develops over time, these anatomic alterations become…
irreversible, resulting in loss of airway caliber. In addition, the cilia are often damaged, and the basement membrane of the mucosa may become thicker than normal (fibrosis)
Remodeling
Cilia damaged, and the basement membrane of the mucosa may become thicker than normal (fibrosis)- remarkable feature of bronchial asthma (does not occur in mild to moderate cases)
The major pathologic or structural changes observed during an asthmatic episode are as follows
- Smooth muscle constriction of bronchial airways (bronchospasm),
- Excessive production of thick, whitish bronchial secretions,
- Mucous plugging,
- Hyperinflation of alveoli (air trapping),
- In severe cases, atelectasis caused by mucous plugging,
- Bronchial wall inflammation leading to fibrosis (in severe cases, caused by remodeling)
Ratio of children/ adults with asthma
1 in 11 children, 1 in 12 adults. Estimated that 25.7 million people in US suffer from asthma
Asthma is nearly twice as prevalent in young___ as young____, in the adults, however, asthma is more common in ___ then ___
Young boys over girls, and women over men
Group of people that account for the disease
Low income and middle income countries account for more than 80% of the mortality.
Asthma authorities are not in full agreement as to how the risk factors for asthma should be categorized but they are…
- Host factors- which are primarily genetic 2. Environmental factors- that trigger the clinical manifestations of (extrinsic) asthma, or a combination of both
Asthma severity in boys generally peaks around age and lessens dramatically during ___
peaks; 5-7 years and lessens dramatically during puberty. Many girls experience the onset of asthma during puberty, in adulthood the prevalence of asthma is greater in women than in men
Host factors include
Genetics, Obesity, and sex and gender
Environmental factors include
Allergens- outdoor and indoor air pollution, infections, Occupational sensitizers, tobacco smoke, diet
Allergens relation to indoor pollutants, such as
smoke and fumes from gas and biomass fuels used for heating and cooling, molds, and cockroach infestation
Infections such as
bacteria infections may cause asthma, but more likely to contribute are viral upper and lower airway infections
Occupational sensitizers is defined as
asthma caused by exposure to an agent encountered in the work environment. cause 1 to 10 cases of asthma amoung adults of working age. Examples of farming, painting, cleaning, and plastic manufactures
Infants of smoking parents are __ times more likely to develop wheezing illnesses in the first year of life
4
diet- Studies have also indicated that certain characteristics of western diets, such as the following, have been associated with asthma
- Increased use of processed foods,
- Decreased antioxidants (in the form of fruits and veggies)
- Increased n-6 polyunsaturated fatty acid,
- Decreased n-3 polyunsaturated fatty acid
Drugs-
Asthma exacerbations are associated with the ingestion of aspirin and other nonsteroidal antiinflammatory drugs. It is estimated that as much as 20% of the asthmatic population may be sensitive to aspirin.
-Beta-blocking drugs administered orally, or intraocular medications for glaucoma, are also associated with asthma
About 5% of the asthmatic population is sensitive to foods and drinks that contain….
sulfites
Other Risk factors
Drugs, Food additives and preservatives, Exercise-induced bronchoconstriction, Gastroesophageal reflux, Sleep (nocturnal asthma), Emotional stress, Perimenstrual asthma, Allergic bronchopulmonary aspergillosis
GERD
Gastroesophageal reflux disease - pt may complain of burning, substernal pain, belching, and a bitter, acid taste, particularly when lying down.
Diagnosis of asthma in early childhood is based primarily on the
assessment of the childs symptoms and physical findings–and good clinical judgement. In the older child and adult, a complete history and physical examination- along with the demonstration of reversible and variable air flow obstruction. In elderly patient, asthma is often undiagnosed because of the presence of comorbid diseases that complicate the diagnosis
Diagnosis of asthma is often missed in the patient who acquires asthma in
the workplace. Form called occupational asthma. Can be misdiagnosed as COPD
Signs and symptoms that should increase the suspicion of asthma, these include___ and a history of any of the following
WHEEZES -Recurrent cough -Recurrent wheeze -Recurrent difficult breathing -Recurrent chest tightness. Other indicators are the occurrence or worsening of symptoms at night or in a seasonal pattern.
Symptoms like the presence of
eczema, hay fever, or a family history of asthma or atopic disease may also be an indicator.
Another sign is if an individual has colds that “go to the chest” or that take more than ___ days to clear up
10 days
Diagnostic and Monitoring tests for asthma
Over pts 5 years of age: FEV1, FEV1/FVC ratio, and peak expiratory flow rate (PERF). These testss measure the severity, reversibility, and variability of air flow limitations
An increase in FEV1 of > __% (or > __mL) after administration of a bronchodilator suggests
> 12% (or >200mL) suggests reversible air flow limitation consistent with asthma
Normally FEV1/FVC ratio is
greater than 0.75 to 0.80, any value less than these values indicate air flow limitation, and asthma should be suspected
Other diagnostic tests for asthma
Measurement of airway responsiveness to inhaled methacholine or histamine, or an indirect challenge test to inhaled mannitol, or an exercise or cold air challenge may be useful in confirming a diagnosis of asthma
Other diagnostic tests can only be performed when the patient has an FEV1
of 80% or greater, to avoid electively inducing significant asthma symptoms in a compromised patient.
A helpful method in confirming the diagnosis of asthma in children 5 years or younger is a trial of treatment with
short acting bronchodilators and inhaled glucocorticosteroids. A marked clinical improvement during the treatment and deterioration when the treatment is stopped supports the diagnosis of asthma.
During an asthmatic episode, the smooth muscles of the bronchi may hypertrophy as much as
three times normal thickness
Asthma is associated with which of the following
Increase in goblet cells, Damage to cilia and deduced mucous clearance, Increase in bronchial gland size
Which of the following have gained a widespread acceptance for assessing and monitoring a pts air flow limitation
q 3
