CHARO ASTHMA
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Transcript of CHARO ASTHMA
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Ma. Rosario A. Angeles
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WHAT IS ASTHMA?
Diffuse, obstructive lung disease with (1)hyperreactivity of the airways to a variety of stimuliand (2) a high degree of reversibility of theobstructive process, w/c may occur either
spontaneously or as a result of treatment. Also known as Reactive Airway Disease, (RAD)
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PATHOPHYSIOLOGY
Manifestations of airway obstruction are due to: Bronchoconstriction Hypersecretion of mucus Mucosal edema Cellular infiltration Desquamation of epithelial and inflammatory
cells
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Mast cells in Asthma Pathogenesis:
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Components of an
Asthma AttackEarly Immune ResponseBronchoconstriction
the consequence of immunoglobulin Edependentmediator release upon exposure to aeroallergens and is theprimary component of the early asthmatic response
normal Asthma attack
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Components of an
Asthma AttackLate phase reactionMucosal edema
occurs 6-24 hours following an allergen challenge and is rto as the late asthmatic response.
Excessive Secretions
Chronic mucous plug formation consists of anexudate of serum proteins and cell debris that maweeks to resolve.
Airway remodeling
associated with structural changes due to long-standing inflammation and may profoundly affect the e
of reversibility of airway obstruction.
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Components of an Asthma
Attack- Edema and Bronchospasmreduction olumen size with resulting increase of wo
breathing and decrease in airflow.
- Mismatching of ventilation w/perfusion
alveolar hypoventilation & Inc work
breathing changes in blood gases
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Components of an Asthma
Attack Hyperventilationcompensates initially for higher CO2tension in the blood that perfuses poorly ventilatedregion, but it cannot compensate for hypoxemiabecause of patients inability to inc. partial pressure ofO2 and oxyhemoglobin saturation further alveolarhypoventilation and hypercapnia occurs
Hypoxia interferes w/conversion of lactic acid to CO2and H20 met acidosis
Hypercapnia increases carbonic acid w/c dissociates
into hydrogen and bicarbonate ions
respi acidosis
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SIGNS AND SYMPTOMS OF AN
ASTHMA ATTACK
Cough
Wheezing
Tachypnea
Dyspnea with prolonged expiration
Use of accesory muscle of respiration
Cyanosis
tachycardia
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Diagnosis- Recurrent episodes of coughing and
wheezing especially if trigerred by exercise, viral
infection or inhalled allergens are highly suggestive
of asthma
- Pulmonary function testing before and after
administration of methacholine or a bronchodilator
or before and after exercise may help establish the
diagnosis of asthma
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Causes:
Factors that can contribute to asthma or airway hyperreactivity mayinclude any of the following: Environmental allergens Viral respiratory infections Exercise; hyperventilation Gastroesophageal reflux disease
Chronic sinusitis or rhinitis Aspirin or nonsteroidal anti-inflammatory drug hypersensitivity, sulfite sensitivity Use of beta-adrenergic receptor blockers (including ophthalmic preparations) Environmental pollutants, tobacco smoke Occupational exposure Emotional factors Irritants such as household sprays and paint fumes
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Lab Studies:
Laboratory studies are not routinely indicated for asthma but maybe used to exclude other diagnoses.
Blood Eosinophilia greater than 250-400 cells/mm3 is usual. Allergy skin testing: useful adjunct in individuals with atopy
Chest radiography: findings are normal or indicatehyperinflation.
.
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Procedures:
Pulmonary function testing (spirometry) Perform spirometry measurements before and after inhalation of a
short-acting bronchodilator in all patients in whom the diagnosis ofasthma is considered. Spirometry measures the forced vital capacity,the maximal amount of air expired from the point of maximal inhalationand the FEV1. A reduced ratio of FEV1 to forced vital capacity, when
compared with predicted values, demonstrates the presence of airwayobstruction. Reversibility is demonstrated by an increase of 12% or 20mL after administration of a short-acting bronchodilator.
The diagnosis of asthma cannot be based on spirometry findings alonbecause many other diseases are associated with obstructivespirometry indices.
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Methacholine- or histamine-
challenge testing
Bronchoprovocation testing with either
methacholine or histamine is useful when
spirometry findings are normal or near normal
CLASSIFICATION OF ASTHMA SEVERITY
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CLASSIFICATION OF ASTHMA SEVERITY
Severity Prior to Initiation of Therapy
Mild Intermittent Mild Persistent ModeratePersistent
Severe Pe
Symptoms < or = 2 per week > 2 per week daily symptoms continual sy
Nighttimesymptoms
< or = 2 per month > 2 per month > 1 per week frequ
Lung function < or = 80%predicted
< or = 80%predicted
> 60% -< or = 80%
< or = 6
Peak flow variability < 20% 20-30% > 30% > 30%
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LONG TERM CONTROL Rx QUICK-RELIEF MEDICATIONS
Corticosteroids***
Cromolyn/nedocromil**Leukotriene modifiers**Methylxanthines**Long-acting beta-agonists*
Short-acting beta-agonists*
Anti-cholinergics*Systemic glucocorticosteroids***
STEP THERAPY BASED ON ASTHMA SEVERITY
Classification Quick Relief Long-Term Control
Step 1: Mild Intermittent prn None.
Step 2: Mild Persistent prn Single agent with anti-inflammatory activity.
Step 3: ModeratePersistent
prn Inhaled corticosteroids, add long-acting bronchodilatorneeded.
Step 4: Severe Persistent prn Multiple long-term control medications. Add oralcorticosteroids if needed.
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PREVENTION:
KNOW THE ASTHMA ATTACK
TRIGGERS!Pets Indoorpollution
Exercise
Pollens
Weather
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How to Use the
Students Health Care PlanRead the health care plan
developed by the school nurseKnow your students asthma
attack triggersBe familiar with emergency
action plansContact school nurse with
questions