Transcript Respiratory Update for SCC Nursing Faculty

Asthma: Causes, Monitoring and
Treatment
Presented by Cynthia Fouts,
June, 2012
Learning Objectives
After viewing this presentation, the learner will be
able to:
 understand the two major classifications of asthma
 list ways to decrease the patient’s exposure to asthma
triggers
 coach the patient in performing peak flow measurements
 write an asthma plan
 classify asthma severity
 choose correct management techniques based on severity.
Background:
 Asthma used to be viewed as a condition that
a person gets, is treated, and suffers no
lasting damage.
 Recent studies have shown that each asthma
exacerbation leaves airway damage behind.
 In addition to physical damage, asthma
exacerbations result in loss of productivity
(both for adults at work and children in
school).
 Asthma sufferers also report that asthma
affects their activities and enjoyment of life
Asthma Types:
There are two major types of asthma:
 Intrinsic – also known as nonallergic or
nonatopic
 Extrinsic – also known as allergic or atopic
Intrinsic
 Etiology – elusive
 Usually occurs after 40 years of age
 Non-specific stimuli:
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Infections
Cold Air Exposure
Exercise
Esophageal Reflux
Emotional Stress
Pollutants
Food Additives, Food Preservatives
Extrinsic
 clearly associated with exposure to a specific
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antigenic agent
Type I anaphylactic hypersensitivity reaction
IgE-mediated allergic reaction
Family related
Usually appears in children
Hypersensitivity immune response causes the
disease by causing acute and chronic
inflammation
Decreasing exposure to triggers:
 Tobacco smoke
 Quit if smoker
 Smoke-free environments (car & house)
 Dust mites
 Encase mattress in special dust-mite free cover
 Encase pillow in special dust-mite free cover or wash
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every week in hot water or cool water/bleach
Reduce indoor humidity to <60%
Do not sleep on cloth covered cushions or furniture
Remove carpets from bedroom and from concrete
Stuffed toys
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Keep out of the bed
Wash weekly in hot water or cool water/bleach
Decreasing triggers, cont’d.
 Animal Dander
 Keep animal with fur out of the home
 Keep pet out of bedroom and keep door closed
 Remove carpet and cloth-covered furniture
 Cockroach
 Keep all food out of the bedroom
 Keep food and garbage in closed containers
 Use poison baits, traps and powders instead of
sprays
Decreasing triggers, cont’d.
 Vacuum cleaning
 Try to get someone else to come in and do the
vacuuming once or twice a week
 If do it yourself, use a mask, central vac
system or vacuum with a HEPA filter
 Indoor mold
 Fix leaky faucets and pipes
 Clean moldy surfaces
 Dehumidify basements
Decreasing triggers, cont’d.
 Pollen and Outdoor Mold
 Keep windows closed during peak allergy seasons
 Stay inside during midday and afternoon
 Talk to doctor about anti-inflammatory meds before
allergy season starts
 Smoke, Strong Odors and Sprays
 If possible do not use wood burning stove, kerosene
heater, fireplace, or any unvented heater
 Stay away from new paint, new carpet, hair spray,
perfumes
Decreasing triggers, cont’d.
 Exercise or Sports
 Check air quality index and avoid outside activity when
air pollution or pollen levels high
 Warm up before exercising
 Should be able to be active without symptoms; if not talk
to dr. about taking meds before activity to prevent
symptoms
 Other triggers
 Avoid Sulfites in foods – beer or wine, shrimp, dried fruit,
processed potatoes
 Cold air – cover mouth and nose with scarf
 Other meds – tell doctor about all meds you are taking
Daily monitoring
 All asthma patients should use a peak flow
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meter to monitor their daily symptoms.
A peak flow meter is a small hand-held device
which measures the speed which a patient
can exhale.
Measurement is in Liters/minute.
Easy to use – even children who can follow
simple directions can use it.
Many times a peak flow meter will show a
decrease in flow before the patient feels an
increased shortness of breath.
Peak Flow Meters –
different styles
How to Use a Peak Flow Meter
 Have patient in upright position
 Instruct to place mouthpiece into their mouth but
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do not obstruct the opening with their tongue
Firmly seal lips around mouthpiece
Take a big breath in
BLAST out the breath – hard and fast!!!
Note reading
Reset meter to zero
Repeat process twice more and record the best
reading
Asthma Zone Management
System
This system is a
process of daily
monitoring using a
peak flow meter,
daily recording of
results, and
treatment based on
those results.
Charting Peak Flow & Zones
You will note on the preceeding
example of a Peak Flow Chart
that there were green, yellow,
and red columns. These
columns represent the 80100%, 50-80%, and <50%
zones of the patient’s personal
best. The personal best is the
best of two weeks of
measurements made during a
time when the patient’s asthma
is well controlled.
Written Action Plan
Written asthma action plans include two
important elements:

Daily management

Recognition and handling worsening
symptoms
Daily Management
 Monitoring with a peak flow meter
 Recording of peak flow measurement
 What medications to take every day; when
and how to take them
Recognition and Handling
Worsening Symptoms
 What symptoms and PF measurements
indicate worsening asthma (yellow zone)
 What medications to take in response to these
signs and symptoms
 What symptoms and PEF measurements
indicate the need for urgent medical attention
(red zone)
 Emergency telephone numbers for the
physician, ED, and person or service to
transport the patient rapidly for medical care
Classification of Asthma
Severity – Mild Intermittent
Symptoms
Nocturnal
Symptoms
Daily Meds for
Long Term
Control
Medication for
Quick Relief
Symptoms no more
frequent than twice a
week.
Asymptomatic and
with normal PF
between
exacerbations.
Exacerbations brief
(hours to days).
Intensity of
Exacerbations varies.
No more
frequent
than twice
monthly
No daily
medications
Short-acting
inhaled β2-agonist
Use more than
twice weekly may
indicate the need
to initiate longterm therapy
Classification of Asthma
Severity – Mild Persistent
Symptoms
Nocturnal
Symptoms
Daily Meds for
Long Term
Control
Medication for
Quick Relief
Symptoms more
frequent than twice
weekly but less than
once per day.
Exacerbation may
affect activity.
More
frequent
than twice
monthly
Once-daily
medication:
Antiinflammatory
agent (low-dose
corticosteroid,
cromolyn)
or
Sustained-release
theophylline
NOTE:
Leukotriene
modifiers may be
considered for pts
at least 12 yr old.
Short-acting
inhaled β2-agonist
Daily use or
increasing use
may indicate the
need to additional
long-term therapy
Classification of Asthma
Severity – Moderate Persistent
Symptoms
Nocturnal
Symptoms
Daily Meds for
Long Term
Control
Medication for
Quick Relief
Daily Symptoms
Daily use of inhaled,
short-acting β2-agonist
Exacerbations affect
activity.
Exacerbations at least
twice weekly and may
last for days.
More
frequent
than once
weekly.
One or two
daily med:
Antiinflammatory
agent (mediumdose inhaled
glucocorticoid)
and/or
Medium-dose
inhaled
glucocorticoid
plus long-acting
bronchodilator
Short-acting
inhaled β2-agonist
Daily use or
increased use
indicates need for
additional longterm therapy
Classification of Asthma
Severity – Severe Persistent
Symptoms
Nocturnal
Symptoms
Daily Meds for
Long Term
Control
Medication for
Quick Relief
Continual symptoms.
Limited physical
activity.
Frequent
exacerbations.
Frequent
Two daily
medications:
Antiinflammatory
agent (high-dose
inhaled
glucocorticoid)
and
Long-acting
bronchodilator
(inhaled or oral
β2-agonist or
theophylline)
Short-acting
inhaled β2-agonist
Daily use or
increased use
indicates need for
additional longterm therapy
Treatment Regimen
 Note that the medications ordered for a
patient are associated with the severity rating
of their asthma.
 It is important to educate the patient on the
correct administration of MDI’s and DPI’s to
ensure adequate intake of the medications.
 It is possible to control almost all asthma with
medication and avoidance of triggers.
Bibliography
Des Jardins, T. and Burton, G. (2006). Clinical Manifestations and
Assessment of Respiratory Disease. St. Louis, Mo: Mosby Elsevier. pg.
197-206.
Guidelines for the Diagnosis and Management of Asthma (EPR-3).
(2007) National Heart Lung and Blood Institute. Retrieved from
http://www.nhlbi.nih.gov/guidelines/asthma/index.htm
Measuring Your Peak Flow Rate. (2012) American Lung Association.
Retrieved from http://www.lung.org/lung-disease/asthma/living-withasthma/take-control-of-your-asthma/measuring-your-peak-flowrate.html
National Asthma Control Initiative. (2008) National Heart Lung and
Blood Institute. Retrieved from
http://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/index.htm