Asthma

A Presentation on Asthma Management and Prevention

 What is Asthma?
Chronic disease of the airways that may cause
Wheezing
Breathlessness
Chest tightness
Nighttime or early morning coughing

Episodes are usually associated with

widespread, but variable, airflow obstruction
within the lung that is often reversible either
spontaneously or with treatment.
 Pathology of Asthma

Asthma
involves
inflammation of
the airways

Normal Asthma

Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma
Created and funded by NIH/NHLBI, 1995
 SYMPTOMS
Asthma signs/symptoms include:

😥 Shortness of breath
😖 Chest tightness or pain
😣 Trouble sleeping caused by shortness of breath,
coughing or wheezing
😫 A whistling or wheezing sound when exhaling
(wheezing is a common sign of asthma in children)
😷 Coughing or wheezing attacks that are
worsened by a respiratory virus, such as a cold
or the flu
Signs that your asthma is probably worsening
include:

😥 Asthma signs and symptoms that are more

frequent and bothersome
😣 Increasing difficulty breathing (measurable
with a peak flow meter, a device used to
check how well your lungs are working)
😫 The need to use a quick-relief inhaler more
often
CAUSES
Asthma Triggers
Asthma triggers
😥 Airborne substances, such as pollen, dust mites,
mold spores, pet dander or particles of
cockroach
waste
😥 Respiratory infections, such as the common
cold
😥 Physical activity (exercise-induced asthma)
😥 Cold air
😥 Air pollutants and irritants, such as smoke
😥Certain medications, including beta blockers,
aspirin,
ibuprofen (Advil, Motrin IB, others) and naproxen
(Aleve)
😥 Strong emotions and stress
😥 Sulfites and preservatives added to some types
of foods and beverages, including shrimp, dried
fruit, processed potatoes, beer and wine
😥 Gastroesophageal reflux disease (GERD), a
condition in which stomach acids back up into
your throat
Risk Factors for Developing Asthma

 Genetic characteristics
 Occupational exposures
 Environmental exposures
Indoor Air Exposures & Asthma Exacerbation
Biological Agents Chemical Agents
 Sufficient evidence of causal  Sufficient evidence of causal
relationship
relationship  Environmental tobacco smoke
 Cat (among pre-school aged children)
 Cockroach  Sufficient evidence of
association
 House dust mite
 NO2, NOX (high levels)
 Sufficient evidence of an association  Limited or suggestive evidence of
 Dog association
 Fungus/Molds  Environmental Tobacco Smoke
(among school-aged, older children,
 Rhinovirus and adults)
 Limited or suggestive evidence of  Formaldehyde
association  Fragrances
 Domestic birds
 Chlamydia and Mycoplasma pneumonia
 RSV
 Reducing Exposure to House Dust Mites

 Use bedding
encasements
 Wash bed linens weekly
 Avoid down fillings
 Limit stuffed animals to
those that can be washed
 Reduce humidity level
(between 30% and 50%
relative humidity per
EPR-3)

Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For
Asthma Created and funded by NIH/NHLBI, 1995
 Reducing Exposure to
Environmental Tobacco Smoke
Evidence suggests an
association between
environmental tobacco smoke
exposure and exacerbations of
asthma among school-aged,
older children, and adults.

Evidence shows an association

between environmental tobacco
smoke exposure and asthma
development among pre-school
aged children.
Reducing Exposure to Cockroaches

Remove as many water and food sources as

possible to avoid cockroaches.
 Reducing Exposure to Pets

People who are allergic to pets should not

have them in the house.

At a minimum, do not allow pets in the

bedroom.
 Reducing Exposure to Mold

Eliminating mold and the moist conditions that permit

mold growth may help prevent asthma exacerbations.
 Nursing Interventions
Assess history. Obtain a history of allergic reactions
to medications before administering medications.

Assess respiratory status. Assess the patient’s

respiratory status by monitoring the severity of
symptoms, breath sounds, peak flow, pulse oximetry,
and vital signs.

Fluid therapy. Administer fluids if the patient is

dehydrated.
Assess medications. Identify medications that the patient is
currently taking. Administer medications as prescribed and
monitor the patient’s responses to those medications;
medications may include an antibiotic if the patient has an
underlying respiratory infection.

Pharmacologic therapy. Administer medications as

prescribed and monitor patient’s responses to medications.

Fluid therapy. Administer fluids if the patient is dehydrated.

 Clinical Management of Asthma
Expert Panel Report 3
National Asthma Education and Prevention Program
National Heart, Lung and Blood Institute, 2007

Source: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
 Diagnosing Asthma:
Medical History

Symptoms
Coughing
Wheezing
Shortness of breath
Chest tightness
Symptom Patterns
Severity
Family History
 Diagnosing Asthma
Troublesome cough, particularly at night
Awakened by coughing
Coughing or wheezing after physical
activity
Breathing problems during particular
seasons
Coughing, wheezing, or chest tightness
after allergen exposure
Colds that last more than 10 days
Relief when medication is used
 Diagnosing Asthma

Wheezing sounds during normal

breathing

Hyperexpansion of the thorax

Increased nasal secretions or nasal

polyps

Atopic dermatitis, eczema, or other

allergic skin conditions
 Diagnosing Asthma:
Spirometry

Test lung function when diagnosing asthma

 Medications to Treat Asthma

Medications
come in several
forms.

Two major
categories of
medications are:
Long-term control
Quick relief
 Medications to Treat Asthma:
Long-Term Control

Taken daily over a long period of time

Used to reduce inflammation, relax airway

muscles, and improve symptoms and lung
function
Inhaled corticosteroids
Long-acting beta2-agonists
Leukotriene modifiers
Medications to Treat Asthma:
Quick-Relief

Used in acute
episodes

Generally short-
acting
beta2agonists
 Medications to Treat Asthma:
How to Use a Spray Inhaler

The health-care
provider should
evaluate inhaler
technique at each
visit.

Source: “What You and Your Family Can Do About Asthma” by the Global Initiative for
Asthma Created and funded by NIH/NHLBI
 Medications to Treat Asthma:
Nebulizer
 Machine produces a
mist of the medication

 Used for small children

or for severe asthma
episodes

 No evidence that it is
more effective than an
inhaler used with a
spacer
Nursing Assessment

Assess the patient’s respiratory status by

monitoring the severity of the symptoms.

Assess for breath sounds.

Assess the patient’s peak flow.

Assess the level of oxygen saturation

through the pulse oximeter.

Monitor the patient’s vital signs.

 Managing Asthma:
Asthma Management Goals
Achieve and maintain control of symptoms
Maintain normal activity levels, including
exercise
Maintain pulmonary function as close to
normal levels as possible
Prevent asthma exacerbations
Avoid adverse effects from asthma
medications
Prevent asthma mortality
 Managing Asthma:
Things People with Asthma Can Do

Have an individual management plan containing

Your medications (controller and quick-relief)
Your asthma triggers
What to do when you are having an asthma attack
Educate yourself and others about
Asthma Action Plans
Environmental interventions
Seek help from asthma resources
Join an asthma support group
A Public Health Response to Asthma:
Interventions
Medical management
Education
Environment
Schools
 A Public Health Response to Asthma:
Environmental Interventions
 Help people create and
maintain healthy home,
school, and work
environments.
 Environmental interventions
may consist of:
 Assessments to identify
asthma triggers
 Education on how to
remove asthma triggers
 Remediation to remove
asthma triggers
 A Public Health Response to Asthma:
School
 A leading chronic disease cause of school absence

 Common disease addressed by school nurses

 Affects teachers, administrators, nurses, coaches,

students, bus drivers, after school program staff,
maintenance personnel
 On average, 3 children in a classroom of 30

are likely to have asthma.*

*Epidemiology and Statistics Unit. Trends in Asthma Morbidity and Mortality. NYC: ALA, July
2006.
What are pulmonary function tests?

Pulmonary function tests (or lung function

tests) include numerous procedures to
diagnose lung problems. The two most
common lung function tests used to
diagnose asthma are spirometry, exhaled
nitric oxide and challenge tests.
Spirometry — This is a simple
breathing test that measures
how much and how fast you
can blow air out of your lungs. It
is often used to determine the
amount of airway obstruction
you have.
Exhaled nitric oxide – Nitric
oxide is a gas that is produced in
the lungs and has been found to
be an indicator of inflammation.
Challenge tests — These tests
might be performed if your
symptoms and screening
spirometry do not clearly or
convincingly establish a diagnosis
of asthma. There are 2 types of
challenge tests: methacholine and
mannitol.
X-ray is an image of the
body that is created by using
low doses of radiation
reflected on special film or a
fluorescent screen
 Resources
 National Asthma Education and Prevention Program
 http://www.nhlbi.nih.gov/about/naepp/
 Asthma and Allergy Foundation of America
 http://www.aafa.org
 American Lung Association
 http://www.lungusa.org
 American Academy of Allergy, Asthma, and
Immunology
 http://www.aaaai.org
 Allergy and Asthma Network/Mothers of Asthmatics,
Inc.
 http://www.aanma.org
 Resources

 American College of Allergy, Asthma, and

Immunology
 http://www.acaai.org
 American College of Chest Physicians
 http://www.chestnet.org
 American Thoracic Society
 http://www.thoracic.org
 The Centers for Disease Control and Prevention
 http://www.cdc.gov/asthma

 https://my.clevelandclinic.org/health/diagnostics/8958-
asthma-testing--diagnosis/test-details
DONE!