MSE 2 Asthma

Asthma

What is Asthma?

  • Chronic inflammatory disorder of the airways.

  • Reversible airflow obstruction (spontaneous or with treatment).

  • Characterized by episodes of:

    • Wheezing

    • Breathlessness

    • Chest tightness

    • Coughing

Why Asthma Matters

  • Affects over 25 million people in the U.S.

  • One of the leading causes of hospitalizations in children.

  • Can be life-threatening if not managed properly.

Normal vs. Asthmatic Airway

  • Asthmatic airway:

    • Inflamed

    • Constricted

    • Mucus-filled

  • Smooth muscle constriction narrows the airway.

  • Triggers cause an exaggerated response.

Early vs. Late Phase Response

  • Early phase:

    • Bronchospasm and narrowing of airways.

  • Late phase:

    • Inflammation, mucus, edema (occurs 4-6 hours later).

    • Late phase often more severe and prolonged.

Asthma Triggers

Environmental Triggers

  • Pollen

  • Pet dander

  • Dust mites

  • Mold

  • Smoke (including vaping)

  • Strong odors

  • Cold air

  • Air pollution

Internal or Lifestyle Triggers

  • Exercise

  • Respiratory infections

  • Emotional stress or anxiety

  • Medications: NSAIDs, beta-blockers

Asthma Classifications

  • Intermittent

  • Mild Persistent

  • Moderate Persistent

  • Severe Persistent

Clinical Manifestations of Asthma

  • Wheezing

  • Dyspnea

  • Chest tightness

  • Cough, often at night or early morning.

  • Increased respiratory rate and anxiety.

Signs of Severe Exacerbation

  • Use of accessory muscles.

  • Diminished or absent breath sounds.

  • Unable to speak full sentences.

  • Cyanosis or altered mental status.

Diagnosis of Asthma

  • Performed through:

    • History and physical exam.

    • Pulmonary function tests (PFTs).

    • Measurement of Peak expiratory flow rate (PEFR).

    • Response to bronchodilators.

Pulmonary Function Tests (PFTs)

  • Measure lung volumes and flow rates.

  • Detect airflow limitation and reversibility.

  • Most commonly used metrics:

    • PEFR (Peak Expiratory Flow Rate)

    • FEV1 (Forced Expiratory Volume in 1 second)

What Is a Peak Flow Meter?

  • Handheld tool to measure Peak Expiratory Flow Rate (PEFR).

  • Detects changes in airway narrowing before symptoms appear.

  • Personal best should be established over 2-3 weeks.

Understanding Peak Flow Zones

  • Green (80–100%): Good control.

  • Yellow (50–80%): Caution – use rescue medications.

  • Red (<50%): Medical alert – seek help!

Steps to Use a Peak Flow Meter

  1. Stand or sit up straight.

  2. Take a deep breath, seal lips around mouthpiece.

  3. Blow out as hard and fast as possible.

  4. Repeat 3 times and record the highest value.

What Is an Asthma Action Plan?

  • Personalized written plan based on peak flow zones.

  • Details medications, when to seek help.

  • Helps prevent emergency room visits and complications.

Nursing Assessment - Subjective Data

  • Reported symptoms: cough, wheezing, dyspnea.

  • Medication adherence and effectiveness.

  • Recent exposure to known triggers.

Nursing Assessment - Objective Data

  • Respiratory rate and effort.

  • Use of accessory muscles.

  • Auscultation: presence of wheezes or decreased breath sounds.

  • Oxygen saturation and vital signs.

Common Nursing Diagnoses

  • Ineffective airway clearance.

  • Impaired gas exchange.

  • Anxiety.

  • Deficient knowledge.

Interventions During an Asthma Attack

  • Administer rescue medications (e.g., albuterol).

  • Position patient in High Fowler's position.

  • Oxygen therapy if needed.

  • Stay calm and remain with the patient.

Interventions for Long-Term Control

  • Teach proper inhaler technique and emphasize adherence.

  • Monitor symptoms and peak flow trends.

  • Support lifestyle changes to avoid triggers.

  • Collaborate with interdisciplinary team.

Preventative Asthma Medications

Inhaled Corticosteroids

  • Examples: fluticasone, budesonide.

  • First-line daily therapy for persistent asthma.

  • Reduce airway inflammation and hyperresponsiveness.

  • Not for use during acute attacks.

Leukotriene Modifiers

  • Example: montelukast (Singulair).

  • Oral anti-inflammatory medication.

  • Block leukotrienes that cause bronchoconstriction and inflammation.

  • May be used for exercise-induced or allergic asthma.

Proper Inhaler Use – Key Teaching

  1. Shake inhaler and exhale fully.

  2. Seal lips and inhale deeply during puff.

  3. Hold breath for 5–10 seconds after inhaling.

  4. Wait 1-2 minutes between puffs if prescribed.

Avoiding Triggers - Patient Teaching

  • Remove rugs and dust-collecting items.

  • Use HEPA filters and allergen-proof bedding.

  • Avoid smoke, pets in bedroom, and cold air.

  • Manage stress and avoid exposure to illnesses.

Nurse’s Role in Asthma Care

  • Assessment and timely interventions.

  • Patient and caregiver education.

  • Reinforce medication adherence and action plans.

  • Monitor for signs of worsening condition.

Summary – Key Points

  • Asthma is chronic and often reversible.

  • Identify triggers and avoid them.

  • Utilize a peak flow meter and develop an action plan.

  • Recognize signs of severe exacerbation.

Obstructive Sleep Apnea

Definition

  • Partial/complete airway obstruction during sleep.

  • Causes tongue/soft palate to fall backward.

  • Episodes last 15-90 seconds, occurring 200-400 times in 8 hours.

  • Results in hypoxemia and hypercapnia.

  • Chronic activation of the sympathetic nervous system contributes to elevated blood pressure and may increase the risk of cardiovascular diseases such as heart attack and stroke.

Triggers of Ventilation

  • Two stimulants trigger ventilation:

    • Startle response – which results in an open airway.

Complications of Obstructive Sleep Apnea

  • Chronic hypoxemia and dysrhythmias result in:

    • Hypertension.

    • Heart failure.

  • Consequences of sleep deprivation include:

    • Irritability.

    • Decreased concentration.

Diagnosis & Management of Obstructive Sleep Apnea

  • Diagnosis is made through:

    • Polysomnography (at home or in an office).

  • Risk factors include:

    • Obesity.

    • Neck circumference > 17 inches.

    • Craniofacial abnormalities affecting upper airway.

    • Age > 65.

    • Males > females.

  • Management options include:

    • Avoiding alcohol/sedatives before bed.

    • Maintaining ideal weight.

    • Sleeping position adjustments.

    • Oral appliance for mild cases.

    • CPAP (continuous positive airway pressure) for moderate/severe cases.

    • Surgery if necessary.

Mild Obstructive Sleep Apnea Management

  • Oral Appliance:

    • Positions the jaw forward.

    • Moves the tongue forward.

Moderate/Severe Obstructive Sleep Apnea Management

  • CPAP Mask.

Comparison of CPAP vs. BiPAP

  • Continuous Positive Airway Pressure (CPAP):

    • Does not augment ventilation other than to maintain upper airway patency.

  • Bilevel Positive Airway Pressure (BiPAP):

    • Inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP) are independently titrated and set.

    • Higher pressure to breathe in; lower pressure to breathe out.