Post on 24-Jun-2020
Goals of Presentation
• Review for RT’s on asthma
(pathophysiology)
• Understand Asthma
Management and Asthma
Education
• Understand how Respiratory
Therapists can provide Asthma
Education services.
• Review asthma medications
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What is Asthma?
• Asthma is a chronic lung disease that inflames and narrows the airways.
• Chronic Diseases need to be managed with education provided to the patients.
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The National Guidelines for Asthma
Diagnosis and Management is the EPR 3
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How do Physicians Diagnose Asthma?
Screenings
• Signs and Symptoms
• Questionnaires (Pediatric Asthma Control & Communication Instrument)
• Spirometry and PFT’s
• Triggers
• Comorbidities
• Allergy testing
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Treatment and Management of Asthma
after Diagnosis
•Patient Education
• Identify triggers
•Prescribe medications and teach proper administration of medications
•Manage comorbidities
•Asthma Action Plans
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Important Points from EPR 3 and Asthma
Management
Four Components of
Asthma Management
Severity And
Control
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Four Components of Asthma
Management from EPR 3
Measures of assessment and monitoring, obtained by objective
tests, physical examination, patient history and patient report, to diagnose
and assess the characteristics and severity of asthma and to monitor
whether asthma control is achieved and maintained (Screening)
Education for a partnership in asthma care
Control of environmental factors and comorbid conditions that affect
asthmaPharmacologic therapy
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Severity
The intrinsic intensity of the disease process. Severity is most easily and directly measured in a patient who is not
currently receiving long-term control treatment.
Control
The degree to which the manifestations of asthma (symptoms, functional impairments, and risks of untoward events) are minimized and the goals of
therapy are met.
Severity and Control
Asthma Severity and Control
Severity
• Intermittent
• Mild Persistent
• Moderate Persistent
• Severe Persistent
Control
• Well Controlled
• Not Well Controlled
• Very Poorly Controlled
Asthma Severity
Asthma Control
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Respiratory Therapy and Asthma
Emergency Room
ICU
Hospital floor therapy
Clinics
Health Fairs
Pulmonary Function Labs
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Respiratory Therapy and Asthma Education
NAECB certifies Asthma Educators (AE-C) AARC certifies Asthma Programs
Respiratory Therapy and
Asthma Education
• Organizations and Asthma Education
•EPR 3 and NAEPP
•AE-C and NAECB
•ASME Certifications and AARC
• Respiratory Therapy and Asthma Education
•Exacerbations
•Screenings and Asthma Management
•Discharge and Asthma Action Plans
Respiratory Therapy and Asthma
Preventative Care
• Asthma Screenings
• Asthma Education and Self-Management
• Asthma Action Plan
• Spirometry and Pulmonary Function Tests
• MDI and Equipment Teaching
Critical Care
• Exacerbation and ER Treatment
• Blood Gas Management
• Airway Management
• Ventilator Management
• Asthma Protocols/Order sets
• Discharge Education
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Asthma Screenings
Asthma Management
Asthma Exacerbations
Respiratory Therapy and Asthma
Recap of Asthma and Asthma Education
• Asthma is a chronic lung disease
that inflames and narrows the
airways.
• Four components of asthma
management
• Severity and Control
• RT’s can be involved with all
aspects of Asthma Management
• ER exacerbations
• Respiratory Failure
• Admission and Discharge from hospital
• Screenings in clinics
• Screenings
• Patients with signs and symptoms
should be screened
• Asthma management starts with a
screening
• Organizations associated with
Asthma
• NHLBI
• NAECB
• AARC
• CDPH
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Goals for Implementing Asthma Education with
UCLA Respiratory Care Services
• To have RT Department and Pediatric
Pulmonology Division provide continuous
education on asthma to RT staff.
• To have RT’s provide education to all
asthmatic patients
• To have RT’s utilize:
• Pediatric Asthma Order set
• PAS
• Inhaler assessment score
• Admission and discharge checklist
• PACCI (Pediatric Asthma Control &Communication
Instrument)
• Asthma action plan
• Guide and incentivize RT’s to
become AE-C’s
• Have UCLA Respiratory Care
Services become ASME certified.
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Pathophysiology of Asthma
• Airway inflammation
• Bronchospasm (airflow obstruction and hyper responsiveness)
• Airway Secretions
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Four Components of Asthma
Management
1. Measures of assessment and monitoring, obtained by objective tests, physical examination, patient history and patient report, to diagnose and assess the characteristics and severity of asthma and to monitor whether asthma control is achieved and maintained (Screening)
2. Education for a partnership in asthma care
3. Control of environmental factors and comorbid conditions that affect asthma
4. Pharmacologic therapy (Medications)
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Goals # 4 Medications
Prevent and reduce symptoms
Prevent inflammation
Reduce inflammation
Prevent bronchospasm
Relieve bronchospasm
Increase secretion mobilization
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Chronic Management and Exacerbation
Treatment
Asthma Management
(Controller Medications)
• Inhaled Corticosteroids
• LABA’s
• Combination inhalers
• Leukotriene Modifiers
• Theophylline
• Antihistamines
• Immunomodulators
• Reflux medications
Exacerbation Therapy
(Rescue Medications)
• Albuterol or Short Acting Beta Agonist
• Systemic steroids (Prednisone, Decadron)
• Anticholinergic (Atrovent)
• Anesthetic agents (halothane, Isoflurane,
sevoflurane)
• Magnesium Sulfate
• Ketamine
• Epinephrine
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Inhaled Asthma Medications
• Short-acting beta agonist
bronchodilators
• Albuterol
• Levalbuterol
• Long-acting beta agonist
bronchodilators
• Serevent
• Inhaled corticosteroids
• Flovent
• Asmanex
• Qvar
• Pulmicort
• Combination medications (inhaled
corticosteroid and long-acting beta
agonist)
• Advair
• Dulera
• Symbicort
• Anticholinergic bronchodilators
• Atrovent
• Spiriva
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Asthma Medications
• Oral/IV Corticosteroids
• Prednisone
• Decadron
• Leukotriene Modifiers
• Singular
• Immunomodulators
• Omalizumab (Xolair)
• Antihistamines
• Zyrtec
• Claritin
• Allegra
• Mast Cell Stabilizer
• Cromolyn
• Xanthines (Bronchodilators)
• Theophylline
• Aminophylline
• Nasal Sprays
• Flonase
• Nasacort
• Nasonex
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Signs and Symptoms of an Asthma
Exacerbation
Signs and Symptoms
• wheezing
• coughing
• chest tightness
• shortness of breath
• agitation
• an increased respiratory rate
• an increased pulse rate
• decreased lung function
• difficulty speaking
• difficulty breathing
When asthma is not managed or controlled it
can lead to:
• Asthma exacerbations
• ER admissions
• Missed days of work or schools
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Treatment and Therapy for Asthma
Exacerbation
Exacerbation
• Vitals
• IV access
• Labs
• Corticosteroids
• Albuterol
• Oxygen
• Chest X-Ray
Respiratory Failure
• Continuous Albuterol
• ABG
• Heliox
• BiPAP
• Intubation
• Sedation
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Corticosteroids
How do Corticosteroids Work?
• All corticosteroids reduce inflammation in the airways that carry air to the lungs.
Why are corticosteroids used?
• Get relief of asthma symptoms during a moderate or severe asthma attack
• Get control of symptoms when you start long-term treatment of asthma after your initial
diagnosis.
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Corticosteroids
Common side effects of long-term treatment with
corticosteroids given by mouth include:
• Slower growth or stunted growth in children.
• Problems with the body's ability to use glucose (diabetes).
• Bone weakening (osteoporosis)
• Hypertension
• Repeated infections, bruising, and skin thinning (atrophy). Corticosteroids also make it less likely
you will have a fever, so that an infection is not always recognized immediately.
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Corticosteroids for Asthma (Inhaled and
IV/Oral)
Oral or IV Steroids
•Methylprednisolone(Medrol,Methylpred, Solu-Medrol)
•Prednisone (Deltasone)
•Prednisolone (Prelone, Pediapred, Opared)
•Dexamethasone (Decadron)
Inhaled Corticosteroids
• Beclamethasone dipropionate (Qvar)
• Budesonide (Pulmicort)
• Budesonide/Formoterol (Symbicort)
• Fluticasone (Flovent)
• Fluticasone/Salmeterol (Advair)
• Mometasone (Asmanex)
• Mometasone/formoterol (Dulera)
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Medications for Asthma Exacerbation in
the Emergency Room
• Oral or IV Steroids
•Prednisolone -1mg/kg PO/PGT daily (40-60 mg max)
•Methylprednisolone-1mg/kg IV q6 hours
• Bronchodilators
•Albuterol -2.5mg, 5 mg, 7.5 mg Q3.
•Continuous Albuterol 0.5mg/kg/hr up to 15 mg/hr.
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Asthma Education Goals
• Prevent ER admissions
• Decrease frequency of symptoms
• Improve quality of life
• Decrease work and school absences
• Use four components of Asthma Management for patients
• Screening
• Education
• Control of triggers and comorbidities
• Medications
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Medications Relationship with Triggers
and Comorbidities
• Long term medications help reduce or prevent comorbidities and triggers that cause asthma exacerbations.
• Patients are at higher risk for asthma exacerbations if comorbidities and triggers are not controlled.
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Asthma Management
Comorbidities and Triggers
• Comorbidities
A comorbid medical disease is a condition that occurs in addition to the primary illness.
For example, a person can have co-
existing asthma (primary illness) and
obesity (comorbid condition).
• Triggers
An asthma trigger is anything that brings on coughing, wheezing,
trouble breathing, and other symptoms in a person with asthma.
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Long term medications help reduce or prevent comorbidities and triggers that
cause asthma exacerbations.
Triggers and Asthma
• Allergens
• Irritants
• Colds/Respiratory Infection
• Exercise
• Stress
• Medication
• Weather
• Pollutants
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Comorbidities and Asthma
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AsthmaGERD
Sinusitis
Rhinitis
Obesity Sleep Apnea
Vocal Cord Dysfunction
Psychological, behavioral
Stress
Common Comorbidity Medications and
Treatment
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• Zantac
• Prilosec
• Prevacid
• Pepcid
GERD
• Antibiotics
• Inhaled Steroids (Nasal)
• Decongestants (Phenylephrine)
• Antihistamines (Zyrtec, Claritin)
• Cough Medicines
Sinusitis and Rhinitis
• Weight loss
• CPAP
• Surgery (tonsils, adenoids)
Obesity and Sleep Apnea
Asthma Medications Chronic
Management or Exacerbation Treatment?
Asthma
Management
• Inhaled Corticosteroids
• LABA’s
• Combination inhalers
• Leukotriene Modifiers
• Theophylline
• Antihistamines
• Immunomodulators
• Reflux medications
Exacerbation
Therapy
• Albuterol or Short Acting Beta Agonist
• Systemic steroids (Prednisone, Decadron)
• Anticholinergic (Atrovent)
• Anesthetic agents (halothane, Isoflurane,
sevoflurane)
• Magnesium Sulfate
• Ketamine
• Epinephrine
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References
• http://www.healthline.com/health/asthma/acute-asthma-exacerbation#symptoms2
• http://annals.org/aim/article/1136284/how-do-corticosteroids-work-asthma
• https://www.uptodate.com/contents/management-of-acute-exacerbations-of-asthma-in-adults
• https://www.webmd.com/asthma/systemic-corticosteroids-for-quick-relief-during-asthma-attacks
• https://www.nhlbi.nih.gov/files/docs/guidelines/04_sec3_comp.pdf
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