100%(1)1 out of 1 people found this document helpful
This preview shows page 1 - 3 out of 12 pages.
Asthma COPD, Pneumonia, and Smoking CessationItalicized -PP additional notesAsthma -reversableoBackgroundCharacterized by pre-disposition to chronic airway inflammation and bronchoconstriction (Narrowed airways)Inflammation and bronchoconstriction cause airway obstructionExpiratory airway limitationRecurrent episodes of wheezing, breathlessness, chest tightness, and coughingClassic symptomsInflammation and bronchoconstriction is reversible with medications Can spontaneously resolveConcept of “out-growing” asthma seen in childrenoDiagnosisMany types of asthmaDetailed history and physical examinationTriggers, environmental factors, and comorbiditiesMost asthma have activation of inflammatory mediators and inflammatory cellsSome patients have a genetic disposition to the development of severe eosinophilic asthmaInflammatory mediators – Histamine, leukotrienes, cytokinesInflammatory cells – mast cell, eosinophilsConfirmed with spirometry and specific pulmonary function testsMeasured at baseline and after use of short acting bronchodilator to test for reversibilityReversibility considered when FEV1 increases by more than 12% with use of a bronchodilatorSpirometryFEV1: How much air can be forcefully exhaled in one secondFVC: After taking a deep breath, the maximum volume of air that is exhaledFEV1/FVC: The percentage of total air capacity (vital capacity) that can be forcefully exhaled in one secondPeak expiratory flow rate (PEFR): measured using a peak flow meter.oMainly used by patient at home to take medications in pre-made planPeak 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 limitationUsing PFM twice daily for two weeks to check PEFR: If average daily PEFR variability is greater than 10% this suggests a diagnosis of asthmaoEnvironmental triggersGeneticsPollutionCigarettes, smokeCold air/weather changes -shrinks airwayPetsDust, pollen, cockroachesPerfume and cosmeticsDrugs (Aspirin, NSAIDs, beta-blockers)oComorbiditiesInfections (colds and viruses) -triggers inflammatory response
Allergic RhinitisGERDObesityObstructive Sleep Apnea (OSA)AnxietyStressDepressionoClassifying severityIs it interfering with ability to function, ADLLung functionHow are they sleeping/waking upHow much are they using the medicationsoGeneral approachSelect treatment according to the initial assessment of asthma severityFollow up in 2-6 weeks. Assess at every visit:AdherenceInhaler techniqueAssess control of risk factors, triggers, and comorbiditiesReview asthma action plan Address patient concernsStep up, maintain treatment, or step-downFollow up visits decrease 1-6 months once control is gained, and every 3 months if a stepdown in treatment is plannedoDrug treatmentsAsthma drugs come in oral, inhaled, and injectable formulations