Asthma COPD.docx - Asthma COPD Pneumonia and Smoking...

Asthma COPD, Pneumonia, and Smoking Cessation Italicized -PP additional notes
 Asthma -reversable
o Background
 Characterized by pre-disposition to chronic airway inflammation and
bronchoconstriction (Narrowed airways)
 Inflammation and bronchoconstriction cause airway obstruction
 Expiratory airway limitation
 Recurrent episodes of wheezing, breathlessness, chest tightness, and coughing
 Classic symptoms
 Inflammation and bronchoconstriction is reversible with medications
 Can spontaneously resolve
 Concept of “out-growing” asthma seen in children
o Diagnosis
 Many types of asthma
 Detailed history and physical examination
 Triggers, environmental factors, and comorbidities
 Most asthma have activation of inflammatory mediators and inflammatory cells
 Some patients have a genetic disposition to the development of severe eosinophilic
asthma
 Inflammatory mediators – Histamine, leukotrienes, cytokines
 Inflammatory cells – mast cell, eosinophils
 Confirmed with spirometry and specific pulmonary function tests
 Measured at baseline and after use of short acting bronchodilator to test for reversibility
 Reversibility considered when FEV1 increases by more than 12% with use of a
bronchodilator
 Spirometry
 FEV1: How much air can be forcefully exhaled in one second
 FVC: After taking a deep breath, the maximum volume of air that is exhaled
 FEV1/FVC: The percentage of total air capacity (vital capacity) that can be
forcefully exhaled in one second
 Peak expiratory flow rate (PEFR): measured using a peak flow meter.
o Mainly used by patient at home to take medications in pre-made plan
 Peak flow meter: used as part of patient’s action plan in order to monitor control.
Can also be used at initial diagnoses to test for variability in expiratory airflow
limitation
 Using PFM twice daily for two weeks to check PEFR: If average daily PEFR
variability is greater than 10% this suggests a diagnosis of asthma
o Environmental triggers
 Genetics
 Pollution
 Cigarettes, smoke
 Cold air/weather changes -shrinks airway
 Pets
 Dust, pollen, cockroaches
 Perfume and cosmetics
 Drugs (Aspirin, NSAIDs, beta-blockers)
o Comorbidities
 Infections (colds and viruses) -triggers inflammatory response

 Allergic Rhinitis
 GERD
 Obesity
 Obstructive Sleep Apnea (OSA)
 Anxiety
 Stress
 Depression
o Classifying severity
 Is it interfering with ability to function, ADL
 Lung function
 How are they sleeping/waking up
 How much are they using the medications
o General approach
 Select treatment according to the initial assessment of asthma severity
 Follow up in 2-6 weeks. Assess at every visit:
 Adherence
 Inhaler technique
 Assess control of risk factors, triggers, and comorbidities
 Review asthma action plan
 Address patient concerns
 Step up, maintain treatment, or step-down
 Follow up visits decrease 1-6 months once control is gained, and every 3 months if a step
down in treatment is planned
o Drug treatments
 Asthma drugs come in oral, inhaled, and injectable formulations
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