Asthma

Asthma

Definition/Etiology:

• Chronic reactive airway disease with airway hyperreactivity, inflammation, and reversible airflow obstruction
• Can be life-threatening. Status asthmaticus is a severe, refractory asthma attack

Common Triggers:

• Allergy induced
  • Environment, (pollution, smoke, cold/dry air, seasonal changes)
  • Medications (ASA, NSAIDs, beta blockers)
  • Food additives, sulfites, tetrazine
• Illness – URI, GERD
• Exercise
• Menses

Pathophysiology:

Very complex – involves airway inflammation, constriction/obstruction, overresponsive bronchi

Clinical Presentation:

• Chest tightness, cough, increased work of breathing
  Wheezing (expiration=early; inhalation=late)- may be audible without stethoscope

Assessment:

• Crackles on auscultation
• Prolonged expiratory time
• Lower lobe breath sounds diminished

Signs of hypoxia – impending respiratory failure

• Silent chest
• Restlessness, somnolence, decreased respiratory effort, bradycardia, periodic apnea

Collaborative Management:

• Peak expiratory flow rate (PEFR)
• sit upright with legs dangling
• Inhale fully, seal circumference of the mouthpiece and exhale fully
• Note position of flow meter
• Repeat 3 times and base treatment decisions on best of the readings

Findings:

• 70–90% of predicted value or personal best, use inhalers
• Less than 70% of predicted value or personal best: seek medical attention
• 40–69% of predicted value or personal best: moderate exacerbation
• Less than 40% of predicted value or personal best: severe exacerbation

Meds:

• Short-acting beta agonists – relax smooth muscles, bronchodilation
• Anticholinergics – inhibits contraction of bronchial smooth muscle, limits mucus
• Corticosteroids – anti-inflammatory, limits mucus
• Magnesium sulfate – inhibits smooth muscle contraction, decreases histamine

Medications Delivery:

• Metered dose inhaler (MDI)
  • use of spacer recommended; increases delivery from 15-85%
• Dry power inhaler
• Nebulizer

Evaluation | Patient Monitoring | Education:

• Avoid known allergens/triggers
• Use hypoallergenic bedding, wash in hot water
• Air purifiers, carpet removal
• Keep cats and dogs outside of the house
• Remain inside with air conditioning during the early morning and midday
• Take medication as directed, pretreat before exercise
• Smoking cessation

Linchpins: (Key Points)

If you treat late, you may have to intubate

• Position of comfort
• Progression prevention and airway management
  • Severity of exacerbation determines clinical presentation and aggression of treatment
• Medication administration
• Trigger management