Asthma COPD.docx - Asthma COPD Pneumonia and Smoking Cessation Italicized-PP additional notes Asthma-reversable o Background Characterized by

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

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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
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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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  • Spring '16
  • Hurd
  •  FEV1,  Inflammation

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