Asthma Michael Haines, MPH, RRT-NPS, AE-C. What is Asthma Asthma is a disease of inflammation and...

AsthmaAsthma

Michael Haines, MPH, RRT-NPS, AE-CMichael Haines, MPH, RRT-NPS, AE-C

What is AsthmaWhat is Asthma

Asthma is a disease of inflammation and Asthma is a disease of inflammation and bronchial smooth muscle constriction that bronchial smooth muscle constriction that causes the trapping of gas and wheezingcauses the trapping of gas and wheezing

Asthma affects children more than adults due to Asthma affects children more than adults due to anatomical diameter of the airway. anatomical diameter of the airway.

You are never cured of asthma, you do however You are never cured of asthma, you do however grow and the affects of asthma often lessen as grow and the affects of asthma often lessen as you growyou grow

Asthma is completely treatable and manageableAsthma is completely treatable and manageable

What is Asthma Continued…What is Asthma Continued…

Asthma is one of the most chronic serious Asthma is one of the most chronic serious diseases in children and adolescents, affecting diseases in children and adolescents, affecting nearly nine million children under the age of 18. nearly nine million children under the age of 18. Fifty to 80% of children with asthma develop the Fifty to 80% of children with asthma develop the symptoms of asthma before the age of 5. symptoms of asthma before the age of 5.

Asthma occurs when a stimulus triggers a Asthma occurs when a stimulus triggers a reaction in the lung mucosa and nervous system reaction in the lung mucosa and nervous system causing muscle constrictioncausing muscle constriction

This stimulus can occur as a result of a allergen This stimulus can occur as a result of a allergen or an irritant such as smoke or an irritant such as smoke

http://www.youtube.com/watch?v=82gn_rDRpHk

Who is at risk to develop asthma?Who is at risk to develop asthma?Asthma is commonly divided into two types: Asthma is commonly divided into two types: allergic (extrinsic) asthma and (extrinsic) asthma and non-allergic (intrinsic) asthma (intrinsic) asthma

Children whose immune systems are not fully developed Children whose immune systems are not fully developed are most at risk for developing the disease. However, are most at risk for developing the disease. However, there are no clear markers to predict who will develop there are no clear markers to predict who will develop asthma and who won't. Studies have shown that factors asthma and who won't. Studies have shown that factors associated with the onset of asthma symptoms in associated with the onset of asthma symptoms in children include: children include:

Infants and young children who wheeze with viral upper Infants and young children who wheeze with viral upper respiratory infections. respiratory infections.

Allergies. The relationship between asthma and allergies Allergies. The relationship between asthma and allergies is very strong. is very strong.

A family history of asthma and/or allergy A family history of asthma and/or allergy Prenatal exposure to tobacco smoke and allergens Prenatal exposure to tobacco smoke and allergens

The most common form of asthma among The most common form of asthma among children is allergic asthma. In this form, children is allergic asthma. In this form, otherwise harmless allergens, such as otherwise harmless allergens, such as dust mites, cat and dog dander or other dust mites, cat and dog dander or other environmental allergens, can trigger an environmental allergens, can trigger an asthma attack. In addition to allergy asthma attack. In addition to allergy symptoms brought on by exposure to symptoms brought on by exposure to these allergens-watery eyes, sneezing and these allergens-watery eyes, sneezing and itching-asthmatics can experience severe itching-asthmatics can experience severe airway constriction.airway constriction.

(Dust mites live primarily in Humid(Dust mites live primarily in Humid

Environments, they are microscopicEnvironments, they are microscopic))

AllergensAllergens

Important treatment= stay away from your allergens!Important treatment= stay away from your allergens!If you don’t know what you are allergic to get a allergy testIf you don’t know what you are allergic to get a allergy test

The Role of Heredity in AsthmaThe Role of Heredity in Asthma

Heredity.Heredity. To some extent, asthma seems to run in families. People To some extent, asthma seems to run in families. People whose brothers, sisters or parents have asthma are more likely to whose brothers, sisters or parents have asthma are more likely to develop the illness themselves. develop the illness themselves.

Atopy.Atopy. A person is said to have atopy (or to be atopic) when he or A person is said to have atopy (or to be atopic) when he or she is prone to have allergies. For reasons that are not fully known, she is prone to have allergies. For reasons that are not fully known, some people seem to inherit a tendency to develop allergies. This is some people seem to inherit a tendency to develop allergies. This is not to say that a parent can pass on a specific type of allergy to a not to say that a parent can pass on a specific type of allergy to a child. In other words, it doesn't mean that if your mother is allergic to child. In other words, it doesn't mean that if your mother is allergic to bananas, you will be too. But you may develop allergies to bananas, you will be too. But you may develop allergies to something else, like pollen or mold. something else, like pollen or mold.

In addition, several factors must be present for asthma symptoms to In addition, several factors must be present for asthma symptoms to develop:develop:

Specific genesSpecific genes must be acquired from parents. must be acquired from parents. Exposure to allergensExposure to allergens or triggersor triggers to which you have a genetically to which you have a genetically

programmed response. programmed response. Environmental factorsEnvironmental factors such as quality of air, exposure to irritants, such as quality of air, exposure to irritants,

behavioral factors such as smoking, etc.behavioral factors such as smoking, etc.

Allergy TestAllergy Test

Skin test- numerous known substances Skin test- numerous known substances are placed on the skin, reactions are noted are placed on the skin, reactions are noted and allergens are then determinedand allergens are then determined

Allergy TestAllergy Test

Besides the skin allergy test they also due Besides the skin allergy test they also due blood testsblood tests

The RAST test measures the levels of the The RAST test measures the levels of the allergy antibody IgE that allergy antibody IgE that

is produced when your is produced when your

blood is mixed with a blood is mixed with a

series of allergens in a series of allergens in a

laboratory. laboratory.

What Happens During an Asthma What Happens During an Asthma Episode?Episode?

During normal breathing, the airways to the lungs are During normal breathing, the airways to the lungs are fully open, allowing air to move in and out freely. But fully open, allowing air to move in and out freely. But people with asthma have inflamed, super-sensitive people with asthma have inflamed, super-sensitive airways. Their triggers cause the following airway airways. Their triggers cause the following airway changes, which in turn cause asthma symptoms:changes, which in turn cause asthma symptoms:

The lining of the airways swellThe lining of the airways swell and become more and become more inflamed inflamed

Mucus clogsMucus clogs the airways the airways Muscles tightenMuscles tighten around the airways (bronchospasm) around the airways (bronchospasm) These changes narrow the airways until breathing These changes narrow the airways until breathing

becomes difficult and stressful, like trying to breathe becomes difficult and stressful, like trying to breathe through a straw stuffed with cotton.through a straw stuffed with cotton.

The lung is lined with a mucosa layer The lung is lined with a mucosa layer which is basically a layer of cells which is basically a layer of cells responsible for lubrication and debris responsible for lubrication and debris movement out of the lungmovement out of the lung

During an allergic reaction and During an allergic reaction and subsequent asthma attack, this mucosa subsequent asthma attack, this mucosa releases histamines from mast cells, releases histamines from mast cells, mucus from goblet cells and inflammatory mucus from goblet cells and inflammatory cells; all of which increase the thickness cells; all of which increase the thickness and narrowing of the airways. and narrowing of the airways.

At the same time the muscle around the At the same time the muscle around the lung tightenslung tightens

Following an Asthma attack; the patient will have Following an Asthma attack; the patient will have congestion and increased sputum production for several congestion and increased sputum production for several

daysdays

CausesCauses

Substances that cause allergiesSubstances that cause allergies (allergens) such as dust (allergens) such as dust mites, pollens, molds, pet dander, and even cockroach droppings. In mites, pollens, molds, pet dander, and even cockroach droppings. In many people with asthma, the same substances that cause allergy many people with asthma, the same substances that cause allergy symptoms can also trigger an asthma episode. These allergens may be symptoms can also trigger an asthma episode. These allergens may be things that you inhale, such as pollen or dust, or things that you eat, things that you inhale, such as pollen or dust, or things that you eat, such as shellfish. It is best to avoid or limit your exposure to known such as shellfish. It is best to avoid or limit your exposure to known

allergens in order to prevent asthma symptoms.allergens in order to prevent asthma symptoms. Irritants in the airIrritants in the air,, including smoke from cigarettes, wood fires, or including smoke from cigarettes, wood fires, or

charcoal grills. Also, strong fumes or odors like household sprays, paint, charcoal grills. Also, strong fumes or odors like household sprays, paint, gasoline, perfumes, and scented soaps. Although people are not gasoline, perfumes, and scented soaps. Although people are not actually allergic to these particles, they can aggravate inflamed, actually allergic to these particles, they can aggravate inflamed, sensitive airways. Today most people are aware that smoking can lead sensitive airways. Today most people are aware that smoking can lead to cancer and heart disease. Smoking is also a risk factor for asthma in to cancer and heart disease. Smoking is also a risk factor for asthma in children, and a common trigger of asthma symptoms for all ages children, and a common trigger of asthma symptoms for all ages

CausesCauses Respiratory infectionsRespiratory infections such as colds, flu, sore throats, and such as colds, flu, sore throats, and

sinus infections. These are the number one asthma trigger in sinus infections. These are the number one asthma trigger in childrenchildren

GERD:GERD: Gastric espohgeal reflux disease, stomach acid can be Gastric espohgeal reflux disease, stomach acid can be aspirated and inflam the airwayaspirated and inflam the airway

ExerciseExercise and other activities that make you breathe harder. and other activities that make you breathe harder. Exercise—especially in cold air—is a frequent asthma trigger. A Exercise—especially in cold air—is a frequent asthma trigger. A form of asthma called exercise-induced asthma is triggered by form of asthma called exercise-induced asthma is triggered by physical activity. Symptoms of this kind of asthma may not appear physical activity. Symptoms of this kind of asthma may not appear until after several minutes of sustained exercise. (When symptoms until after several minutes of sustained exercise. (When symptoms appear sooner than this, it usually means that the person needs to appear sooner than this, it usually means that the person needs to adjust his or her treatment.) The kind of physical activities that can adjust his or her treatment.) The kind of physical activities that can bring on asthma symptoms include not only exercise, but also bring on asthma symptoms include not only exercise, but also laughing, crying, holding one's breath, and hyperventilating (rapid, laughing, crying, holding one's breath, and hyperventilating (rapid, shallow breathing). The symptoms of exercise-induced asthma shallow breathing). The symptoms of exercise-induced asthma usually go away within a few hoursusually go away within a few hours

More Causes…More Causes… WeatherWeather such as dry wind, cold air, or sudden changes such as dry wind, cold air, or sudden changes

in weather can sometimes bring on an asthma episode. in weather can sometimes bring on an asthma episode. Expressing strong emotionsExpressing strong emotions like anger, fear or like anger, fear or

excitement. When you experience strong emotions, your excitement. When you experience strong emotions, your breathing changes -- even if you don’t have asthma. breathing changes -- even if you don’t have asthma. When a person with asthma laughs, yells, or cries hard, When a person with asthma laughs, yells, or cries hard, natural airway changes may cause wheezing or other natural airway changes may cause wheezing or other asthma symptoms. asthma symptoms.

Some medicationsSome medications like aspirin can also be related like aspirin can also be related to episodes in adults who are sensitive to aspirin. to episodes in adults who are sensitive to aspirin. Irritants in the environment can also bring on an asthma Irritants in the environment can also bring on an asthma episode. These irritants may include paint fumes, smog, episode. These irritants may include paint fumes, smog, aerosol sprays and even perfume. aerosol sprays and even perfume.

Why Does My Asthma Act Up at Night?Why Does My Asthma Act Up at Night? For reasons we don't fully understand, For reasons we don't fully understand,

uncontrolled asthma -- with its underlying uncontrolled asthma -- with its underlying inflammation -- often acts up at night. It inflammation -- often acts up at night. It probably has to do with natural body probably has to do with natural body rhythms and changes in your body’s rhythms and changes in your body’s hormones, as well as the fact that some hormones, as well as the fact that some symptoms appear hours after you come in symptoms appear hours after you come in contact with a trigger. contact with a trigger.

Also during sleep you release less Also during sleep you release less norepinephrine (adrenaline) which acts as norepinephrine (adrenaline) which acts as your bodies natural bronchodilatoryour bodies natural bronchodilator

Symptoms Symptoms

SymptomsSymptoms Coughing.Coughing. Coughing from asthma is often worse at Coughing from asthma is often worse at

night or early in the morning, making it hard to sleep. night or early in the morning, making it hard to sleep. Wheezing.Wheezing. Wheezing is a whistling or squeaky sound Wheezing is a whistling or squeaky sound

when you breathe. when you breathe. Chest tightness.Chest tightness. This can feel like something is This can feel like something is

squeezing or sitting on your chest. squeezing or sitting on your chest. Shortness of breath.Shortness of breath. Some people say they can't catch Some people say they can't catch

their breath, or they feel breathless or out of breath. You their breath, or they feel breathless or out of breath. You may feel like you can't get enough air in or out of your may feel like you can't get enough air in or out of your lungs. lungs.

Tachypnea and tachycardiaTachypnea and tachycardia DesaturationDesaturation**In children the only symptom may be a persistent cough, In children the only symptom may be a persistent cough,

that occurs more the morningthat occurs more the morning

Status AsthmaticusStatus Asthmaticus As severe asthma attack not responsive to bronchodilatorsAs severe asthma attack not responsive to bronchodilators Typically requires intubation and mechanical ventilation due to Typically requires intubation and mechanical ventilation due to

respiratory failurerespiratory failure Typically, patients present a few days after the onset of a viral Typically, patients present a few days after the onset of a viral

respiratory illness, following exposure to a potent allergen or irritant, respiratory illness, following exposure to a potent allergen or irritant, or after exercise in a cold environment. Frequently, patients have or after exercise in a cold environment. Frequently, patients have underused or have been underprescribed anti-inflammatory therapy. underused or have been underprescribed anti-inflammatory therapy. Illicit drug use may play a role in poor adherence to anti-Illicit drug use may play a role in poor adherence to anti-inflammatory therapy. Patients report chest tightness, rapidly inflammatory therapy. Patients report chest tightness, rapidly progressive shortness of breath, dry cough, and wheezing and may progressive shortness of breath, dry cough, and wheezing and may have increased their beta-agonist intake (either inhaled or have increased their beta-agonist intake (either inhaled or nebulized) to as often as every few minutes. nebulized) to as often as every few minutes.

Vitals signs and Lab tests used to diagnose:Vitals signs and Lab tests used to diagnose: Periods of coughing, wheezing, shortness of breath, or Periods of coughing, wheezing, shortness of breath, or

chest tightness that come on suddenly or occur often or chest tightness that come on suddenly or occur often or seem to happen during certain times of year or season seem to happen during certain times of year or season

Colds that seem to "go to the chest" or take more than 10 Colds that seem to "go to the chest" or take more than 10 days to get over days to get over

Medicines you may have used to help your breathing Medicines you may have used to help your breathing Your family history of asthma and allergies Your family history of asthma and allergies What things seem to cause asthma symptoms or make What things seem to cause asthma symptoms or make

them worse. them worse.

Early and Late Early and Late Asthmatic ResponseAsthmatic Response

Late response is usually more severe and Late response is usually more severe and longer lasting.longer lasting.

SpirometrySpirometry The test measures how much air and how fast you can The test measures how much air and how fast you can blow air out of your lungs after taking a deep breath. The blow air out of your lungs after taking a deep breath. The results will be lower than normal if your airways are results will be lower than normal if your airways are inflamed and narrowed, as in asthma, or if the muscles inflamed and narrowed, as in asthma, or if the muscles around your airways have tightened up. Sometimes around your airways have tightened up. Sometimes bronchial provocation is used to trigger an attack and bronchial provocation is used to trigger an attack and then bronchodilators are given to test for reversibility then bronchodilators are given to test for reversibility (Asthma is the only reversible COPD and is considered (Asthma is the only reversible COPD and is considered very treatable). A substance such as methacholine, very treatable). A substance such as methacholine, which causes narrowing of the airways in asthma, is which causes narrowing of the airways in asthma, is inhaled. The effect is measured by spirometry. Children inhaled. The effect is measured by spirometry. Children under age 5 usually cannot use a spirometer under age 5 usually cannot use a spirometer successfully. If spirometry cannot be used, the doctor successfully. If spirometry cannot be used, the doctor may decide to try medication for a while to see if the may decide to try medication for a while to see if the child's symptoms get better. child's symptoms get better.

SpirometrySpirometry

DiagnosisDiagnosis

Diagnosis of Asthma is made with clinical symptoms and Diagnosis of Asthma is made with clinical symptoms and assessment; allergy awareness; PFT’s that show assessment; allergy awareness; PFT’s that show reverability of >10% post bronchodilator and the ruling reverability of >10% post bronchodilator and the ruling out of other possible problems. To rule out asthma the out of other possible problems. To rule out asthma the doctor would order:doctor would order:

1.1. A chest X-ray (asthmatics usually have normal CXR; use A chest X-ray (asthmatics usually have normal CXR; use to find foreign bodies)to find foreign bodies)

2.2. Tests to see if you have Tests to see if you have gastroesophageal reflux gastroesophageal reflux diseasedisease (GERD) (GERD)

3.3. EKG: Rule out cardiac problems that may lead to SOB EKG: Rule out cardiac problems that may lead to SOB and cardiac wheezingand cardiac wheezing

4.4. ABG not necessarily usefulABG not necessarily useful

Once Diagnosed…Once Diagnosed…

Based on symptoms, the four levels of asthma severity classification Based on symptoms, the four levels of asthma severity classification are: are:

Mild Intermittent (comes and goes)Mild Intermittent (comes and goes)----when your asthma is not well when your asthma is not well controlled, you have asthma symptoms twice a week or less, and controlled, you have asthma symptoms twice a week or less, and you are bothered by symptoms at night twice a month or less. you are bothered by symptoms at night twice a month or less.

Mild persistentMild persistent asthma-- asthma--when your asthma is not well controlled, when your asthma is not well controlled, you have asthma symptoms more than twice a week, but no more you have asthma symptoms more than twice a week, but no more than once in a single day. You are bothered by symptoms at night than once in a single day. You are bothered by symptoms at night more than twice a month. You may have asthma attacks that affect more than twice a month. You may have asthma attacks that affect your activity. your activity.

Moderate persistentModerate persistent asthmaasthma--when your asthma is not well -when your asthma is not well controlled, you have asthma symptoms every day, and you are controlled, you have asthma symptoms every day, and you are bothered by nighttime symptoms more than once a week. Asthma bothered by nighttime symptoms more than once a week. Asthma attacks may affect your activity. attacks may affect your activity.

Severe persistentSevere persistent asthmaasthma--when your asthma is not well -when your asthma is not well controlled, you have symptoms throughout the day on most days, controlled, you have symptoms throughout the day on most days, and you are bothered by nighttime symptoms often. In severe and you are bothered by nighttime symptoms often. In severe asthma, your physical activity is likely to be limited.asthma, your physical activity is likely to be limited.

Treatment Treatment Treatment and Management-Treatment and Management-Avoiding things that bring on your asthma symptoms or make symptoms Avoiding things that bring on your asthma symptoms or make symptoms

worse. Doing so can reduce the amount of medicine you need to worse. Doing so can reduce the amount of medicine you need to control your asthma. Allergy medicine and allergy shots in some control your asthma. Allergy medicine and allergy shots in some cases may help your asthma. cases may help your asthma.

Using asthma medicines. Using asthma medicines. Medications for asthma. There are two main types of medicines for Medications for asthma. There are two main types of medicines for

asthma: asthma:

1. 1. Quick Relief medicinesQuick Relief medicines give rapid, short-term treatment and are give rapid, short-term treatment and are taken when you have worsening asthma symptoms that can lead to taken when you have worsening asthma symptoms that can lead to asthma episodes or attacks. You will feel the effects of these asthma episodes or attacks. You will feel the effects of these medicines within minutes.medicines within minutes.

2. 2. Long-term Control medicinesLong-term Control medicines are taken every day, usually over long are taken every day, usually over long periods of time, to control chronic symptoms and to prevent asthma periods of time, to control chronic symptoms and to prevent asthma episodes or attacks. You will feel the full effects of these medicines episodes or attacks. You will feel the full effects of these medicines after taking them for a few weeks. People with persistent asthma need after taking them for a few weeks. People with persistent asthma need long-term control medicines.long-term control medicines.

Treatment Cont…Treatment Cont…

Quick Acting Drugs are called Beta 2 Quick Acting Drugs are called Beta 2 Adrenergic Bronchodilators. They include Adrenergic Bronchodilators. They include such drugs as Albuterol and Xopenexsuch drugs as Albuterol and Xopenex

They react within minutes and generally They react within minutes and generally last between 4-8 hourslast between 4-8 hours

MDIMDI

or or

NebulizerNebulizer

Treatments Cont…Treatments Cont…

Fast Acting Bronchodilators work to quickly relax Fast Acting Bronchodilators work to quickly relax bronchial smooth muscle. bronchial smooth muscle.

Long Acting Drugs work to maintain open lungs Long Acting Drugs work to maintain open lungs but are not to be given during an acute attack. but are not to be given during an acute attack.

Steroids are long acting drugs; common ones Steroids are long acting drugs; common ones include Advair, Azmacort and Pulmicortinclude Advair, Azmacort and Pulmicort

AdvairAdvair

AzmacortAzmacort

Treatments Continued…Treatments Continued…

Other treatments include drugs that Other treatments include drugs that prevent mast cells from releasing prevent mast cells from releasing histamines; such as Singular and other histamines; such as Singular and other allergen targeted drugs (given before allergen targeted drugs (given before attack occurs)attack occurs)

Avoiding AllergensAvoiding Allergens Mast Cell inhibitors such as Intal or ForadilMast Cell inhibitors such as Intal or Foradil Allergy Shots given annuallyAllergy Shots given annually

Mosby items and Mosby items and derived items © 2009 by derived items © 2009 by Mosby, Inc., an affiliate Mosby, Inc., an affiliate of Elsevier Inc.of Elsevier Inc. 3333

PharmacotherapyPharmacotherapyCorticosteroidsCorticosteroids

Most effective mediation in treatment of asthmaMost effective mediation in treatment of asthma• Reduces symptoms and mortalityReduces symptoms and mortality

Use of inhaled steroids for long-term treatment preferredUse of inhaled steroids for long-term treatment preferred• Use spacer and rinse mouth to eliminate or minimize Use spacer and rinse mouth to eliminate or minimize

side effectsside effects Long-term use of oral steroids should be restricted to Long-term use of oral steroids should be restricted to

patients with asthma refractory to other treatment.patients with asthma refractory to other treatment. Short-term oral steroid use during exacerbation reduces Short-term oral steroid use during exacerbation reduces

severity, duration, and mortalityseverity, duration, and mortality..


Pharmacotherapy (cont.)Pharmacotherapy (cont.)Cromolyn (NSAID)Cromolyn (NSAID)

Protective against allergens, cold air, exercise Protective against allergens, cold air, exercise Administered prophylactically, CANNOT be used during an Administered prophylactically, CANNOT be used during an

acute asthma attackacute asthma attack Of limited use in adults Of limited use in adults Drug of choice for atopic children with asthmaDrug of choice for atopic children with asthma

Nedocromil (NSAID)Nedocromil (NSAID) Similar to cromolyn, it is 4–10 times more potent in Similar to cromolyn, it is 4–10 times more potent in

preventing acute allergic bronchospasm.preventing acute allergic bronchospasm.


Pharmacotherapy (cont.)Pharmacotherapy (cont.)

Leukotriene inhibitorsLeukotriene inhibitors Leukotrienes mediate inflammation and bronchospasm. Leukotrienes mediate inflammation and bronchospasm. Modestly effective to control mild to moderate asthmaModestly effective to control mild to moderate asthma

Inhaled steroids remain the antiinflammatory drug of Inhaled steroids remain the antiinflammatory drug of choice for the treatment of asthma.choice for the treatment of asthma.

MethyxanthinesMethyxanthines (use is controversial) (use is controversial) Oral or IV use if admitted for acute asthma attackOral or IV use if admitted for acute asthma attack



22-Adrenergic agonists-Adrenergic agonists Most rapid and effective bronchodilator Most rapid and effective bronchodilator Drug of choice for exercise-induced asthma Drug of choice for exercise-induced asthma

and emergency relief of bronchospasmand emergency relief of bronchospasm• Should be used PRNShould be used PRN

Improves symptoms not underlying Improves symptoms not underlying inflammationinflammation• Regular use may worsen asthma control and Regular use may worsen asthma control and

increase risk of death.increase risk of death.



AnticholinergicsAnticholinergics Can be used as adjunct to first-line Can be used as adjunct to first-line

bronchodilators if there is an inadequate bronchodilators if there is an inadequate responseresponse

Has an additive affect to Has an additive affect to 22-agonists-agonists


Asthma and Environmental Asthma and Environmental ControlControl

Recognized relationship between asthma and allergy Recognized relationship between asthma and allergy 75–85% asthma patients react to inhaled allergens75–85% asthma patients react to inhaled allergens

Environmental control is aimed at reducing exposure to allergens.Environmental control is aimed at reducing exposure to allergens. Avoid outdoor allergens by remaining inside, windows closed, Avoid outdoor allergens by remaining inside, windows closed,

AC onAC on Indoor allergens are combated byIndoor allergens are combated by

• Air purifiers and no petsAir purifiers and no pets• Dust mites: airtight covers on bed and pillow, no carpets in Dust mites: airtight covers on bed and pillow, no carpets in

bedroom, chemical agents to kill mitesbedroom, chemical agents to kill mites


Special Considerations in Special Considerations in Asthma Management (cont.)Asthma Management (cont.)

Nocturnal asthma Nocturnal asthma Present in two-thirds of poorly controlled asthmaticsPresent in two-thirds of poorly controlled asthmatics May be due to diurnal decrease in airway tone or gastric refluxMay be due to diurnal decrease in airway tone or gastric reflux Treatment should include:Treatment should include:

• Steroid treatment targeted to relieve night symptomsSteroid treatment targeted to relieve night symptoms• Sustained release theophylline Sustained release theophylline

• New long-acting New long-acting 22-agonists-agonists

• Antacids for reflux Antacids for reflux



Aspirin sensitivityAspirin sensitivity 5% of adult asthmatics will have severe, life-threatening asthma 5% of adult asthmatics will have severe, life-threatening asthma

attacks after taking NSAIDs.attacks after taking NSAIDs. All asthmatics should avoid; suggest Tylenol use.All asthmatics should avoid; suggest Tylenol use.

Asthma during pregnancyAsthma during pregnancy A third of asthmatics have worse control at this time.A third of asthmatics have worse control at this time. Much higher fetal risk associated with uncontrolled asthma than Much higher fetal risk associated with uncontrolled asthma than

that of asthma medicationsthat of asthma medications

Theophyllines, Theophyllines, 22-agonists, and steroids can be used without -agonists, and steroids can be used without

significant risk of fetal abnormalities.significant risk of fetal abnormalities.



Sinusitis may cause asthma exacerbation.Sinusitis may cause asthma exacerbation. CT of sinuses will diagnosis problem.CT of sinuses will diagnosis problem. Treat: 2–3 weeks antibiotics, nasal decongestants, and nasal Treat: 2–3 weeks antibiotics, nasal decongestants, and nasal

inhaled steroidsinhaled steroids

SurgerySurgery Asthmatics at higher risk for respiratory complicationsAsthmatics at higher risk for respiratory complications

• Arrest during induction Arrest during induction • Hypoxemia with/without hypercarbiaHypoxemia with/without hypercarbia• Impaired cough, atelectasis, pneumoniaImpaired cough, atelectasis, pneumonia

Optimize lung function preoperatively. Optimize lung function preoperatively. Use steroids during procedure.Use steroids during procedure.

Using a Peak FlowUsing a Peak Flow

A Peak Flow device is a assessment tool A Peak Flow device is a assessment tool used to measure the effectiveness of fast used to measure the effectiveness of fast acting bronchodilators.acting bronchodilators.

Given during the attack, before and after Given during the attack, before and after treatmentstreatments

It is a handheld device that the patient It is a handheld device that the patient exhales forcibly on; as the airway opens exhales forcibly on; as the airway opens and improves, the value increasesand improves, the value increases

Peak Flow Continued…Peak Flow Continued…

http://www.youtube.com/watch?v=CZHO_JCTjXo

ConclusionConclusion

Asthma is a disease of inflammation and Asthma is a disease of inflammation and bronchial muscle constrictionbronchial muscle constriction

Caused by sensitive lungs that swell when Caused by sensitive lungs that swell when introduced to an allergen or irritantintroduced to an allergen or irritant

Symptoms include cough, wheezing, chest Symptoms include cough, wheezing, chest congestion and tightness and SOBcongestion and tightness and SOB

Diagnose with PFT, symptoms and allergy testDiagnose with PFT, symptoms and allergy test Treat with Bronchodilators, Steroids, Allergen Treat with Bronchodilators, Steroids, Allergen

Medications and avoidance of allergies.Medications and avoidance of allergies.

Asthma Michael Haines, MPH, RRT-NPS, AE-C. What is Asthma Asthma is a disease of inflammation and...

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