Asthma Triggers and Health Promotion
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SignificanceAsthma affects about 16 million Americans
Adult females have a greater prevalence of asthma than males
Female death rate greater than males
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TriggersBring on symptoms of asthma
Different from person to person
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TriggersAsthma cannot be cured, but can be managed
Goal in asthma - minimize exposure to triggers
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Triggers of Asthma Triggers of Asthma AllergensAllergensAbout 40% of cases are related to an allergic responseMay be seasonal or year round depending on exposure to allergen
Nonseasonal forms of asthma may be year round (perennial) Related to allergens such as dust
mites, molds, animalsCockroaches
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Nursing ManagementHealth Promotion - Allergens Dust mites like warm places
Bedding, upholstered furniture, carpeting, and stuffed toys
Control dust and dust mites Put mattresses and pillows in
special allergen-proof covers Wash bedding every week in hot
water
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Nursing ManagementHealth Promotion - Allergens Control dust and dust
mites Remove dust collectors
from the bedroom Dust woodwork and wash
curtains often Use a damp mop on floors
instead of sweeping
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Nursing ManagementHealth Promotion - Allergens Control dust and dust
mites Vacuum carpets/rugs
weekly Avoid using humidifiers and
use dehumidifiers in damp parts of the house
Replace air conditioner and furnace filters monthly
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Nursing ManagementHealth Promotion - Allergens Control mold indoors
Basements, kitchens, and bathrooms should be kept as clean and dry as possible.
Humidifiers and vaporizers should be avoided.
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Nursing ManagementHealth Promotion - Allergens Control mold outdoors
Stay inside in air conditioning on damp, windy days
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Nursing ManagementHealth Promotion - Allergens Control mold
Keep bathroom dry by using an exhaust fan or dehumidifier
Clean sinks, tubs, and showers with bleach solution (1 part bleach, 3 parts water)
Limit house plants Clean spacers and nebulizers
often
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Nursing ManagementHealth Promotion - Allergens Control pollen
Weather reports tell when pollen counts are high
Pollen levels can be obtained on Internet by going to sites such as www. Pollen.com
Pollen counts are lower in the evening so that is a better time to go outdoors
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Nursing ManagementHealth Promotion - Allergens Control pollen
During allergy season, use air conditioning instead of opening windows
Change the air conditioner filter monthly
Shower or bathe after being outdoors
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Nursing ManagementHealth Promotion - PetsKeep pets out of bedroom and living areas
Brush and wash pets weeklyUse feather pillowsCat litter emptied by nonallergic person
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Triggers of Asthma Exercise Induced or exacerbated after exerciseTypically occur after vigorous exercise
Pronounced with exposure to cold air
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Nursing ManagementHealth Promotion - ExerciseMedications to promote bronchodilation 10-20 minutes before exercise Cromolyn (Intal), nedocromil (Tilade), β2-agonists
Warm up 2-3 minutes by exercising slowly at first
Limit exercise if ill or if the weather is cold and dry
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Triggers of Asthma Air Pollutants Can trigger asthma attacks
Cigarette or wood smokeVehicle exhaustElevated ozone levelsSulfur dioxide
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Triggers of Asthma Health Promotion - Air Pollutants Ozone alert days
Noted in newspaperMinimize outdoor activity during these times
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Nursing ManagementHealth Promotion - SmokingDo not allow smoking in home or car
Do not use wood burning stoves or fireplaces
Avoid campfires
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Triggers of Asthma Occupational FactorsMost common form of occupational lung diseaseExposure to diverse agents
Arrive at work well, but experience a gradual decline during day
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Nursing ManagementHealth Promotion – Occupational Factors
Nurse needs to obtain a health historyAssess if symptom-free when not at work
Use masks and proper ventilation
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Triggers of Asthma Respiratory Infection Major precipitating factor of an acute asthma attack↑ inflammation hyperresponsiveness of the tracheobronchial system
Viruses cause asthma by activating immune system
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Nursing ManagementHealth Promotion - InfectionsAvoid people with colds and flu
Get a yearly flu shot Wash hands oftenEat well Get plenty of sleep
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Triggers of AsthmaNose and Sinus ProblemsAllergic rhinitis and nasal polypsLarge polyps are removed Sinus problems are usually related to inflammation of the mucous membranes
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Triggers of AsthmaDrugs and Food AdditivesAsthma triad: nasal polyps, asthma, and sensitivity to aspirin and NSAIDs
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Triggers of AsthmaDrugs and Food AdditivesSymptoms related to asthma triadWheezing develops in about 2 hrs
Rhinorrhea, congestion, tearing
Facial flushing, GI symptomsNeed to avoid aspirin and NSAIDs
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Triggers of AsthmaDrugs and Food Additivesβ-blockers may trigger asthmaPropanolol (Inderal)Timolol (Timoptic)
Inhibit adrenergic stimulation of bronchioles and prevent bronchodilation
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Triggers of AsthmaDrugs and Food AdditivesSulfites may trigger asthma
Used in dried fruits, wine, beer, shrimp, and salad bars
Used as preservative in eye solutions, IV corticosteroids, inhaled bronchodilators
Can cause breathing difficulty for many people with asthma
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Triggers of AsthmaDrugs and Food AdditivesFood allergies may cause asthma symptomsAvoidance diets Rare in adults
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Triggers of AsthmaGastroesophageal Reflux Disease
>75% of people with asthma experience GERD
Those with severe asthma more likely to have GERD
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Triggers of AsthmaGastroesophageal Reflux Disease
Chronic backward flow of stomach acid into esophagus
Causes burning sensation called heartburn
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Triggers of AsthmaGastroesophageal Reflux Disease
Exact mechanism causing asthma is unknownReflux of acid could be aspirated into lungs, causing vagal stimulation and bronchoconstriction
Treated with H2-histamine blockers and proton pump inhibitors ma
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Triggers of Asthma Health Promotion - GERD
Raise head of bed by 6 inches to allow gravity to keep contents in stomach
Eat meals at least 3-4 hours before lying down, and avoid bedtime snacks
Eat smaller meals Maintain healthy weight to eliminate intra-abdominal pressure caused by extra pounds
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Triggers of Asthma Health Promotion - GERD
Limit fatty foods, chocolate, peppermint, coffee, tea, colas and alcohol - all of which relax the lower esophageal sphincter (LES)
Limit tomatoes and citrus fruits or juices, which contribute additional acid that can irritate the esophagus
Do not smoke, which also relaxes the LES
Wear loose belts and clothing
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Triggers of AsthmaEmotional StressPsychological factors can worsen the disease processAttacks can trigger panic and anxiety
Extent of effect is unknown
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Case Study A 30-year-old African America woman comes to the emergency department (ED) with severe wheezing, dyspnea, and anxiety
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Case Study Her history indicates she
had a recent cold that did not resolve
had taken a new job at a dry cleaners and laundromat
was having regurgitation of food after eating which she related to the stress from her recent divorce
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Case Study Her history indicates:
she was upset that her children had just brought home a stray cat
she did not know if she was allergic to it
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Case Study Health Promotion StrategiesTeach patient to identify and avoid possible triggersUpper respiratory tract infection
Work environmentStress and GERD
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