Asthma

Asthma

Epidemiology
1. 2.4 million people in Canada (2014)
2. More prevalent in females (57.45%)
3. Major cause of hospitalization in children (ages 0-11)
Pathophysiology
1. Hyperresponsive airways
  1. Bronchiole obstruction
2. May be reversible in early stages
  1. Can become irreversible (COPD) with subsequent asthma attacks
3. Main Characteristics
  1. Bronchospasm
  2. Edema in bronchiole mucosa due to inflammation
  3. Excess mucus production
4. 2 Main Types of Asthma
  1. Intrinsic
    1. Type I hypersensitivity to inhaled allergen/antigen
    2. Family history of other allergy (atopic)
    3. Antigen binds to IgE in respiratory mucosa
    4. Usually start in childhood and may have a remission in adolesence
  2. Extrinsic
    1. Asthma with non-allergen triggers
      1. Respiratory tract infection
      2. Exposure to cold temperature
      3. Exercise
      4. Stress
      5. Dehydration
      6. Aspirin and other drugs
    2. Onset is usually in adulthood
    3. No IgE involvement, usually more severe, and often not responsive to pharmacological treatment
Clinical Manifestations
1. Wheezing
2. Cough
3. Dyspnea
4. Tightness in the chest
5. Tachypnea
6. Low SpO2
7. Diminished Breath Sounds
Diagnostic Studies
1. Detailed medical history
2. Physical examination
3. Pulmonary Function Tests
4. Peak Flow Monitoring
5. Chest X-ray
6. Arterial Blood Gases
7. Oximetry
8. Allergy Testing
9. Blood levels of eosinophils
10. Sputum culture and sensitivity
Nursing Management
1. Pharmacological
  1. Short-acting β2-adrenergic agonists
    1. Salbutamol
    2. Terbulatine
    3. Immediate response for acute use (4-8 hours)
      1. Before exercise/other stimuli
        Caution: rebound bronchospam if overused
    4. Onset of action: minutes
  2. Long-acting β2 agonist bronchodilators
    1. Salmeterol (Serevent)
    2. 12 hours duration
      1. nocturnal and poorly controlled asthma
        combined with inhaled corticosteroid
  3. Anti-inflammatory drugs
    1. Corticosteroids (Fluticasone, Budesonide, Beclomethasone)
      1. Inhaled form common
        Systemic form for severe asthma
  4. Anticholinergic drugs
    1. Ipratropium
      1. Causes bronchodilation
2. Patient Teaching
  1. Proper use of puffer/aerochamber
  2. Control exposure to triggers
  3. Seek medical help if...
    1. Cyanosis (Call 9-1-1)
    2. Symptoms unrelieved by medication
    3. Severe chest pain/tightness
    4. Decrease in level of consciousness
Risk Factors
1. Modifiable
  1. Exposure to trigger factors
    1. Change in temperature
    2. Pollution
    3. Pollens
    4. Mould and spores
    5. animal fur/dander
    6. Perfumes/sprays
    7. Cigarette smoke
    8. House dust miles
    9. Exercise and Stress
  2. Being overweight
2. Non-Modifiable
  1. Genetics/Family History of asthma
  2. Having another allergic condition (atopic dermatitis/allergic rhinitis/hay fever)

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