class 7 asthma Flashcards
jan 30th
what is asthma
inflammation fo the airways characterized by paroxysmal or persistent symptoms such a dyspnea, wheezing, sputum production and cough
what happens in the airways with asthma
-airway is more irritable or “twitchy”
-chronic inflammation
-excessive mucus production
-airway remodeling
what are the symptoms of asthma
-chronic cough
-wheeze
-chest tightness
-shortness of breath
when do symptoms occur?
-worse at night/morning
-with viral respiratory infection
-after exposure to allergens
-after exercise
-after playing/laughing
comorbidities for asthma
-allergic rhinitis
-chronic sinusitis
-GERD
-obesity
how is asthma diagnosed in children <6 years of age
-clinical history of recurrent symptoms
-improvement in symptoms with therapy
-no suspicion of alternative diagnosis
-family hx of asthma, allergies, and/or eczema
how is asthma diagnosed in children > 6 years and adults
-clinical history
-pulmonary function test (PFT)
-methacholine challenge test
what is pulmonary function test (spirometry)
-preferred diagnostic test
-measure how much and how fast you can blow air out of your lungs
-FEV1 improves >12% after bronchodilator or >20% after 2 weeks of inhaled steroid
what is a methacholine challenge
-perform baseline spirometry first
-increasing concentrations of methacholine given via neb. FEV1 is measured after each inhalation (>20% change is significant)
-measures airway hyperresponsiveness
education needed for people dx with astma
-what it is
-identify triggers/discuss avoidance
-reliever therapy prn
-medications daily
-inhaler technique
-adherence to meds
-written action plan
-regular assessments of asthma control
non-allergic triggers (irritants)
-dust
-exercise
-tobacco smoke
-wood smoke
-strong scents
-viral infections
-weather changes
-air pollution
environmental control outside of the home
-plan ahead
-avoid smoke/vapour
-remove pets
home environmental controls
-mold/mildew removal
-no carpets
-hypoallergenic mattress/pillow cover
-bed linen washed 1x week
-humidity
education for exercise-induced asthma
-warm-up before
-cool down after
-use bronchodilator 10-15 minutes before
-avoid outdoor exercise when pollution/pollen count is high
-cover mouth and nose when exercising in cold
-always carry blue puffer (bronchodilator)
reliever medications for asthma
-short acting bronchodilators (ventolin, bricanyl)
-used PRN to tx acute s&s
-relax tightened muscles around the airways allowing them to open up
-work in 10-15 mins lasts 4h
-side effects: inc HR & tremors, may develop tachyphylaxis is used too regularly
controller medications for asthma
-anti-inflammatory steroids (flovent, pulmicort, alvesco, qvar, asmanex)
-used DAILY
-used if 1 or more indicators of poor control
-controls swelling and mucus production inside the airways
-works slowly
-side effects: thrush, hoarseness, mild decrease in growth (monitor ht &wt)
combination medication for asthma
-inhaled steroid and long acting beta agonist (advair, symbicort, zenhale)
-used on a daily basis
-control swelling inside the airway and relaxes tight muscles on the outside airway
-symbicort & zenhale only in children 12+
leukotriene receptor antagonist for asthma
-class of anti-inflammatory (singulair, montelukast)
-taken orally, daily, in the evening
prednisone for asthma
anti-inflammatory
-used to treat acute exacerbations
-given orally for 3-7 days
-dose 1mg/kg/day
how to use aerochamber with mask for med delivery
-open inhaler cap
-shake 10 times
-insert inhaler into spacer
-place and seal mask over nose/mouth
-press down on inhaler once
-take 6 breaths
-wait 30 sec to repeat if needed
-rinse & spit after medication, wash face
how to use aerochamber with mouthpiece
-open inhaler cap
-shake 10 times
-insert into spacer
-breath out, seal lips around mouthpiece
-press down on inhaler once
-take a slow deep breath hold 10s (or 6 normal breaths)
-wait 30s to repeat if needed
-rinse n spit
how to use turbuhaler
hold upright
-twist opne & remove cover
-turn coloured base counter clockwise
-turn base back to click
-breath out AWAY from device
-seal lips around mouthpiece
-take a quick deep breath & hold 10s
-wait 30s to repeat if needed
-rinse n spit
-replace cover
how to use diskus
-push open with thumb
-slide lever away from you until a click is heard
-breath out away from diskus
-seal lips around mouthpiece
-take a full deep breath in hold 10s
-close
-rinse n spit
canadian guideliens for good asthma control
daytime s&s: <4 days/week
nightime s&s: <1 night/week
-exercise: normal
-exacerbations: mild, infreq
-school absence: none
-bronchodilator use: <4 dose/week
-FEV 1: >90% personal best
-PEF: >90% personal best
asthma education goals
-prevent exacerbations
-improve quality of life & ADLs
-reduce airway damage & med side effects
-reduce morbidity & mortality
-reduce health care costs
