Transcript File - Respiratory Therapy Files

EXTRINSIC ASTHMA /
ATOPIC
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Asthma can be characterized by
recurrent dyspnea
with airway inflammation and wheezing
due to spasmodic constriction of
the bronchi.
An acute attack that lasts for several da
ys is known as status asthmaticus. (life
threatening)
250,000–345,000 people die per year from
the disease
More common in boys than girls
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3 CLASSIFICATIONS
OF ASTHMA
Allergic or atopic asthma is
EXTRINSIC asthma; due to an allergy to antigens.
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INTRINSIC asthma; usually secondary to
chronic or current infections of the bronchi,
sinuses, or tonsils and adenoids (large lymphatic
tissue) can be caused by hypersensitivity to
bacteria / viruses.
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The third type of asthma is MIXED; due to
combination of extrinsic and intrinsic factors.
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Attacks can be stimulated by infections,
emotional factors, and exposure to variety
of irritants.
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MOST COMMON IS
EXTRINSIC ASTHMA
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Extrinsic Asthma associated with
inherited genetics.
Linked to hypersensitivity to the
immune response.
Triggered by allergic disorders,
emotional stress, environmental c
hanges in humidity and temperatu
re, and exposure to noxious
fumes or other airborne allergens.
ALLERGEN
TRIGGERS
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Allergens suspended in the air;
from pollen, dust, smoke, mold,
dust mites, automobile
exhaust, or animal dander.
Environmental factors.
Exercising / Stress can also trigger
asthma attacks.
SYMPTOMS OF
ASTHMA ATTACK
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Signs include dyspnea with wheezing
in respiration’s
Classic sitting position, leaning forwar
d using all the accessory muscles
of respiration.
Skin can be pale with moist
precipitation.
Severe attacks can show cyanosis of
lips and nail beds.
PHARMOCOLOGY
MANAGEMENT
Short-acting B2 - agonists
Adrenergics B2 - stimulants
Sympathomimetics stimulants.
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Stimulates adenylyl cyclase activity; closing of
calcium channel (smooth muscle relaxation)
Albuterol/salbutamol
Fenoterol
Levalbuterol
Metaproterenol
Pirbuterol
Terbutaline
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LABA'S
Formoterol
Salmeterol
When coupled
with
corticosteroids
may prolong anti
inflamation
response .
PHARMOCOLOGY
MANAGEMENT
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(Antihistamines) block the
actions of histamine which
is a mediator in the
inflammation response.
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Zyrtec
Palgic
Clarinex
Benadryl
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Common uses for Alergic
Rhinitis
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(Anti-Leukotrienes)
work by blocking a
chemical reaction that can
lead to inflammation
Montelukast
Zafirlukast
(Anti-IgE)
Keeps inflammation from
developing. Blocks
immunoglobulin E,
substance in the body
which causes of
inflammation in allergic
asthma.
Omalizumab (Xolair)
Cromolyn sodium
PHARMACOLOGY
MANAGEMENT
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Corticosteroids AKA
Glucocorticoids ; Anti
inflammatory /
immunosuppressant
medications are given in
severe cases.
Beclomethasone
Budesonide Ciclesonide
Flunisolide
Fluticasone Mometasone
Triamcinolon
hydrocortisone
methylprednisolone
prednisolone
prednosone
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(Combinations
Drugs)
mixture of
Corticosteroid and
LABA'S.
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Symbicort
Advair
PFT / SPIROMETRY TESTING
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Most accurate in ages
above 7 yrs
Obstructive pattern in
PFT testing.
This includes a decrease
in the rate of maximal
expiratory air flow (a
decrease in FEV1 and
the FEV1/FVC ratio) due
to the increased
resistance, and a
reduction in forced vital
capacity (FVC).
PEF / PEAK FLOW TESTING
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If PEF drops below 80% of your
personal best, follow your
asthma action plan. Age &
Height – appendix guide.
Consider; peak flow
measurements are not reliable
for the younger aged.
Not reliable during acute
attacks.
In younger population more
attention should be given to
asthma symptoms.
STATUS ASMATICUS
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Acute exacerbation of
asthma that remains
unresponsive to initial
treatment of
bronchodilators.
Can vary from a mild
to severe with
bronchospasm,
airway inflammation,
mucus plugging that
can cause difficulty
breathing, carbon
dioxide retention,
hypoxemia.
Can lead to
respiratory failure.
*Management goals for status
asthmaticus.
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(1) To reverse airway
obstruction rapidly through the
aggressive use of beta2agonist agents
(2) Early use of corticosteroids.
(3) to correct hypoxemia by
monitoring and administering
supplemental oxygen,
(4) to prevent or treat
complications such as
pneumothorax and respiratory
arrest.
*Typically, patients present a few days after the onset of a viral respiratory
illness, following exposure to a potent allergen or irritant, or after exercise in a
cold environment. Frequently, patients have underused or have been
underprescribed anti-inflammatory therapy.
PATIENT EDUCATION
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Providing asthma education to the
patient and family is a must.
Educating for maintenance,
monitoring and measures for
environmental control.
Instruction in the appropriate use of
inhalers.
Compliant with therapy, and to
practice stress-avoidance measures.
Stress factors (ie, triggers of asthma
attacks) include pet dander, house
dust, and mold.
Discourage patients from smoking
ect...
THOUGTS FOR TREATMENT.
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No permanent cure for
extrinsic asthma.
Avoiding the discussed
triggers is best way to
control symptoms.
Plan of care must be
highly individualized to
meet patient needs
Encourage patient and
family involvement in
care planing.