Introduction to the Study of Asthma
27
September

By Adem Lewis / in , , /


Continuing our study of chronic
obstructive lung diseases, this short video will introduce asthma. Asthma is
classified as a chronic obstructive lung disease, but unlike emphysema, chronic
bronchitis, and bronchiectasis, asthma is intermittent with sporadic attacks.
It does not typically destroy lung tissue. Between asthma attacks many
patients will demonstrate normal lung function and have no complaints of
difficulty breathing. It is not uncommon for some patients with asthma to have a
persistent level of airway inflammation and a cough. Where the primary cause of
emphysema, chronic bronchitis, and bronchiectasis is the use of tobacco
products, the most common cause of asthma is allergies. An asthma attack will
result in bronchoconstriction or narrowing of the bronchi and bronchioles,
caused by constriction of the smooth muscles that wrap around the to tube like
structures. An attack includes an increase in in airway inflammation, that
you can see in the picture here, that reduces the inner lumen of the bronchial tube. There may also be tightening of the smooth muscle that wraps around the
bronchioles and this further constricts the inner
lumen of the bronchiol making air flow more difficult. The anatomical changes
result in frequent coughing and wheezing that may often be heard without the aid
of a stethoscope. Unlike emphysema, chronic bronchitis, and
bronchiectasis where there is tissue destruction, asthma has a degree of
reversibility with bronchodilator medications. Asthma may be seen
alone or it may occur in conjunction with other chronic obstructive lung
diseases. Just a few fast facts about asthma.
Statistics from the Centers for Disease Control and Prevention tell us that
one in 13 Americans will have asthma, and in children that number is about 1 in 12.
that total is about 25 million asthmatic patients to be treated when needed, and
educated to self-manage for an improved quality of life .With a smaller airway
diameter, the patients that we see in the hospital emergency room or as inpatients
in the hospital are most commonly children.
Statistically more boys than girls will develop asthma as children. In the adult
population, women more often than men will be diagnosed with asthma, and women
will be more likely to die than men. For the adults we will see that adults are
four times more likely to die from asthma than children during an attack.
Although we know much more about medications for treating asthma,
diagnosing asthma, and controlling asthma, every day we’ll see an average of 10
Americans die of an asthma attack. There’s no cure for asthma. It is however
treatable and the goal becomes prevention of attacks and management of
symptoms so the patients may enjoy a reasonable quality of life. Some patient
cases will be more severe and more difficult to manage. As a respiratory
therapist, it’s important that you understand the disease and the treatment
in order to best serve your patients and their families. Asthma is expensive in a
number of ways it is the leading chronic illness in children and the number one
cause of missed school days. Because it is children with trouble breathing, each
of those thirteen point eight million missed school days leads to a similar
number of caregivers who must be off work. Rare is the daycare provider who
says “Sure bringing me your wheezy blue child! I’d be happy to have them at my house.”
The medications, physician office visits, ER visits, and hospitalizations
add up to almost eighty two billion dollars per year.
Asthma can have a significant impact on quality of life factors. Avoiding
triggers often means avoiding leisure activities and some sports. The trip to
the mall past the Bath and Body Works may be a trigger for some. There can be no
family dog or cat because my brother, my sister, my mom or dad, somebody in the
family, has asthma. The day’s plans often carry the unspoken “We will go… We will do…
if your asthma is okay. There’s no cure for asthma, however there are a number of
medications now available to control the underlying inflammation and
control the constriction of the smooth muscles. Diagnosis of asthma
requires attention to patient history. “How do you feel now?” “What brought you in?”
“When did it start?” “What were you doing when it started?” “What
have you eaten?” “Has this ever happened to you before?” “What were you doing then?” “What
have you tried to make it better?” “What has worked? What didn’t work?” Pulmonary
function testing (PFT) is a primary diagnostic tool for asthma. Often a patient with
intermittent asthma attacks will have minimal to no symptoms on the scheduled
date for a pulmonary function test. Administration of aerosolized
methacholine may be used to stimulate an asthma like reaction. Post pulmonary
function test, the patient will then be given a medication to reverse the attack
that was caused by the administration of the methacholine. As an obstructive lung
disease the ability to exhale is compromised for patients with asthma.
daily use of the peak flow meter to measure peak expiratory flow rate may be
a useful tool. Routine use on good days allows the establishment of the
patient’s own personal best. That number can then be used as a baseline normal
for that patient. It’s more useful than comparing the patient’s everyday values
to the normal values based on patients that have no lung disease. As you
complete the readings and videos in the unit you’ll be learning about the many
medications now available for the treatment of acute asthma attacks and to
control asthma symptoms. The fast-acting medications have a quick
onset to action of 3 to 5 minutes, and a relatively short duration of only 3 to 4
hours. Long-acting medications have a longer
onset to action of up to an hour, but a much longer duration of 12 to 24
hours. Confusing them can lead to serious, even deadly outcomes. A few medications
are available in multiple formulations, others will only be available as a
solution or as a metered dose inhaler or as a dry powder inhaler. Each one of them
has different technique for proper administration. Many of’s the MDI and DPI’s
will have a proprietary administration device.
For that reason you will want to watch the manufacturer instructional videos in
the links on Cobra. Asthma treatment is largely based on the frequency and
severity of symptoms. The GIna guidelines, developed by the Global Initiative for
Asthma, provide a five-step plan for advancing medication interventions based
on the level of control of symptoms needed. Page 214 in the Clinical
Manifestations text includes a very useful chart of the guideline. As you
complete the study of asthma, read the text, read the online links to articles,
visit the website links. There is a draft chapter outline if you find that an
outline helps for study purposes. Complete the practice, ungraded quiz to
assess your retention, and the question at the back of the chapter in the text.


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