Exposure to occupational chemicals • Exercise • Cold air • Changes in weather or temperature • Environmental change—Moving to new home, starting new school, etc. • Colds and infections • Animals—Cats, dogs, rodents, horses • Medications—Aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), antibiotics, β-blockers • Strong emotions—Fear, anger, laughing, crying • Conditions—Gastroesophageal reflux, tracheoesophageal fistula • Food additives—Sulfite preservatives • Foods—Nuts, milk/dairy products • Endocrine factors—Menses, pregnancy, thyroid disease Pathophysiology of Asthma The mechanisms responsible for the obstructive symptoms in asthma include: (1) Inflammatory response to stimuli; (2) Airway edema and accumulation and secretion of mucus; (3) Spasm Of the smooth muscle of the bronchi and bronchioles, which decreases the caliber of the bronchioles (4) Airway remodeling, which causes permanent cellular changes Diagnosis of Asthma Diagnosis is determined primarily on the basis of clinical manifestations, history, physical examination, and, to a lesser extent, laboratory tests Pulmonary Function Tests (Lung disease degree) Spirometry Bronchoprovocation Testing- testing mucous membranes to specific antigens Exercise Challenge Tests Skin Pricking and Serologic Testing- To ID environmental allergens CBC- eosinophils greater than 500/mm 3 suggest inflammatory or allergic disorder Peak Expiratory Flow Rate – measures airflow forcefully exhaled in 1 second Therapeutic management Allergen control PATIENT TEACHING: “Allergy-Proofing” the Home and Community • Keep humidity between 30% and 50%; use dehumidifier or air conditioner if available; keep air conditioners clean and free of mold; do not use vaporizers or humidifiers. • Encase pillows in zippered allergen-impermeable covers or wash pillows in hot water every week. • Encase mattress and box springs in zippered allergen-impermeable cover. • Use foam rubber mattress and pillows or Dacron pillows and synthetic blankets. • Wash bed linens every 7 to 10 days in hot water (at least 54.4° C). • Encase polyester comforters in allergen-impermeable covers or wash in hot water (at least 54.4° C) every week; if possible, do not use comforters and use cotton blankets. • Have air and heating ducts cleaned annually; change or clean air filters every 3 months; cover heating vents with filter material (e.g., cheesecloth) to prevent circulation of dust, especially when heat is turned on after summer. • Use wipeable furniture (wood, plastic, vinyl, or leather) in place of upholstered furniture; avoid rattan or wicker furniture. • Keep child indoors while lawn is being mowed, bushes/trees are being trimmed, or pollen count is high.
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