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Asthma
Triggers and Health
Promotion
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Significance
Asthma affects about 20 million
Americans
Adult females have a 30% greater
prevalence of asthma than males
Female death rate 42% greater than
males
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers
Bring on symptoms of asthma
Different from person to person
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers (cont’d)
Asthma cannot be cured, but can be
managed
Goal in asthma - minimize exposure to
triggers
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Allergens
About 40% of cases are related to an
allergic response
May 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,
animals
Cockroaches
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health 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
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)
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
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)
Control dust and dust mites (cont’d)
Vacuum carpets/rugs weekly
Avoid using humidifiers and use
dehumidifiers in damp parts of the
house
Replace air conditioner and furnace
filters monthly
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)
Control mold indoors
Basements, kitchens, and bathrooms
should be kept as clean and dry as
possible.
Humidifiers and vaporizers should be
avoided.
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)
Control mold outdoors (cont’d)
Stay inside in air conditioning on damp,
windy days
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)
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
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)
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
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)
Control pollen (cont’d)
During allergy season, use air
conditioning instead of opening
windows
Change the air conditioner filter
monthly
Shower or bathe after being outdoors
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Pets
Keep pets out of bedroom and living areas
Brush and wash pets weekly
Use feather pillows
Cat litter emptied by nonallergic person
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Exercise
Induced or exacerbated after exercise
Typically occur after vigorous exercise
Pronounced with exposure to cold air
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Exercise
Medications 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
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Air Pollutants
Can trigger asthma attacks
Cigarette or wood smoke
Vehicle exhaust
Elevated ozone levels
Sulfur dioxide
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Health Promotion - Air Pollutants
Ozone alert days
Noted in newspaper
Minimize outdoor activity during these
times
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Nursing Management
Health Promotion - Smoking
Do not allow smoking in home or car
Do not use wood burning stoves or
fireplaces
Avoid campfires
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Occupational Factors
Most common form of occupational
lung disease
Exposure to diverse agents
Arrive at work well, but experience a
gradual decline during day
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion – Occupational Factors
Nurse needs to obtain a health history
Assess if symptom-free when not at work
Use masks and proper ventilation
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
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
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Infections
Avoid people with colds and flu
Get a yearly flu shot
Wash hands often
Eat well
Get plenty of sleep
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Nose and Sinus Problems
Allergic rhinitis and nasal polyps
Large polyps are removed
Sinus problems are usually related to
inflammation of the mucous membranes
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Drugs and Food Additives
Asthma triad: nasal polyps, asthma,
and sensitivity to aspirin and NSAIDs
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Drugs and Food Additives (cont’d)
Symptoms related to asthma triad
Wheezing develops in about 2 hrs
Rhinorrhea, congestion, tearing
Facial flushing, GI symptoms
Need to avoid aspirin and NSAIDs
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Drugs and Food Additives (cont’d)
β-blockers may trigger asthma
Propanolol (Inderal)
Timolol (Timoptic)
Inhibit adrenergic stimulation of
bronchioles and prevent
bronchodilation
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Drugs and Food Additives (cont’d)
Sulfites 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
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Drugs and Food Additives (cont’d)
Food allergies may cause asthma
symptoms
Avoidance diets
Rare in adults
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Gastroesophageal Reflux Disease
>75% of people with asthma
experience GERD
Those with severe asthma more likely
to have GERD
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Gastroesophageal Reflux Disease (cont’d)
Chronic backward flow of stomach
acid into esophagus
Causes burning sensation called
heartburn
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Gastroesophageal Reflux Disease (cont’d)
Exact mechanism causing asthma is
unknown
Reflux of acid could be aspirated into
lungs, causing vagal stimulation and
bronchoconstriction
Treated with H2-histamine blockers and
proton pump inhibitors
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
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 intraabdominal pressure caused by extra
pounds
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Health Promotion - GERD (cont’d)
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
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Emotional Stress
Psychological factors can worsen the
disease process
Attacks can trigger panic and anxiety
Extent of effect is unknown
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Case Study
A 30-year-old African America woman
comes to the emergency department
(ED) with severe wheezing, dyspnea,
and anxiety
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Case Study (cont’d)
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
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Case Study (cont’d)
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
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Case Study
Health Promotion Strategies
Teach patient to identify and avoid
possible triggers
Upper respiratory tract infection
Work environment
Stress and GERD
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Case Study
Health Promotion Strategies (cont’d)
Teach patient to identify and avoid
possible triggers (cont’d)
Cat??
Review medication regimen
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.