Asthma, COPD and CF

• Asthma is a chronic inflammatory disorder of the airways that causes airway hyper-responsiveness leading to wheezing, breathlessness, chest tightness, and cough
• About 8.4% of Canadians over the age of 12 are living with asthma
• Triggers of asthma include allergens (seasonal or year-round), tobacco and marijuana smoke, exercise, respiratory infections, nose and sinus conditions, medications and food additives, GERD, air pollutants, emotional stress, and genetics
• In asthma, the early-phase response is characterized by bronchospasm, increased mucus secretion, edema formation, and increased amounts of tenacious sputum, while the late-phase response is primarily inflammation
• Clinical manifestations of asthma include recurrent episodes of wheezing, breathlessness, cough, and tight chest, particularly at night or early morning, with unpredictable and variable symptoms
• Complications of asthma can include status asthmaticus, which is a form of acute asthma attack with serious and prolonged manifestations
• Diagnostic studies for asthma include detailed history and physical exam, pulmonary function tests, chest X-ray, arterial blood gases and oximetry during acute episodes, allergy testing, blood levels of eosinophils, and sputum culture and sensitivity
• Interprofessional care for asthma involves establishing partnerships between health care providers and patients, identification and avoidance of triggers, patient and family teaching, continuous assessment of asthma control and severity, appropriate pharmacotherapy, asthma action plan, and regular follow-up
• Medication therapy for asthma includes controllers (anti-inflammatory medications and bronchodilators) for persistent asthma and relievers (bronchodilators and anticholinergics) for exacerbations
• Corticosteroids suppress the inflammatory response and reduce bronchial hyper-responsiveness in asthma, with inhaled forms used for long-term control and systemic forms for exacerbations and persistent asthma
• Bronchodilators for asthma include β-Adrenergic agonists, Methylxanthines, and Anticholinergics, each with specific actions and common adverse effects
• Medication therapy for asthma includes antileukotrienes like zafirlukast and montelukast, which block the action of leukotrienes, having both bronchodilator and anti-inflammatory effects
• Antileukotrienes are not indicated for acute attacks but are used for prophylactic and maintenance therapy
• Biological therapy for asthma includes anti-IgE medications like omalizumab (Xolair), which decreases circulating free IgE levels and prevents IgE from attaching to mast cells, thus preventing the release of chemical mediators
• Patient teaching related to medication therapy for asthma emphasizes correct administration of medications, with inhalation being preferable to avoid systemic adverse effects
• Nursing management involves assessing the patient's health history, current health, past health, symptoms like wheezing and coughing, and conducting a focused respiratory assessment
• Nursing management planning for asthma aims for the patient to participate in normal activities with little interference, have the asthma under control, and experience few or no adverse effects from medication
• Nursing management implementation also involves environmental control to reduce triggers like allergens and irritants, as well as self-monitoring and action plans for every person with asthma
• COPD is a preventable disease characterized by airflow limitation not fully reversible, usually progressive, with cardinal symptoms like dyspnea, difficulty breathing, and limitations in activity
• The etiology of COPD includes tobacco smoke as the primary cause, occupational chemicals and dust, air pollution, and infection
• Pathophysiology of COPD involves airflow limitations during forced exhalation due to loss of elastic recoil, inflammation, and destruction of lung tissue
• Clinical manifestations of COPD develop slowly and include cough, sputum production, dyspnea, and exposure to risk factors
• COPD classification ranges from mild to very severe, with stages determined by symptoms, disability, and impairment of lung function
• Complications of COPD include cor pulmonale, acute exacerbations, acute respiratory failure, depression, anxiety, and panic
• Diagnostic testing for COPD involves history and physical examination, pulmonary function tests, chest radiography, and arterial blood gas measurements
• Interprofessional care for COPD aims to prevent progression, reduce exacerbations, alleviate breathlessness, improve exercise tolerance, and treat complications
• Oxygen therapy is used in COPD to reduce the work of breathing, maintain PaO2, and improve prognosis, mental acuity, and exercise tolerance
• Surgical therapy for COPD includes lung volume reduction surgery, bullectomy, and lung transplantation to enhance performance and improve outcomes
• Complications of oxygen therapy:

  • Humidification is used because O2 has a drying effect on the mucosa
• Interprofessional Care for COPD includes:

  • Surgical therapy like lung volume reduction surgery, bullectomy, and lung transplantation
  • Pulmonary rehabilitation programs to optimize functional status through exercise conditioning, breathing exercises, energy conservation, nutrition, smoking cessation, health promotion, patient education, self-management, psychological support, and vocational rehabilitation
• Breathing exercises in COPD help decrease dyspnea, improve oxygenation, slow respiratory rate, and include techniques like pursed-lip breathing, diaphragmatic breathing, effective coughing, and huff coughing
• Nutritional therapy for COPD includes:

  • Maintaining a body mass index (BMI) between 21 and 25 kg/m2
  • Resting before eating, using a bronchodilator before meals, having 5-6 small meals a day, and consuming 1.2-1.3 times normal calorie requirements to maintain weight
  • Following a high-calorie, high-protein diet, having 2-3 L fluid intake per day between meals, and avoiding gas-forming foods
• Age-related considerations in COPD involve reduced lean body mass, decreased respiratory muscle strength, increased dyspnea, lower exercise tolerance, higher incidence of acute exacerbations, and comorbidities with polypharmacy
• Nursing assessment for COPD includes:

  • Health history assessment for symptoms like anorexia, weight loss or gain, early satiety, difficulty eating, decreased activity level, dyspnea, palpitations, recurrent cough, and more
  • Physical assessment for integumentary, respiratory, cardiovascular, gastrointestinal, and musculoskeletal signs
• Nursing management planning for COPD aims to prevent disease progression, improve daily living activities, relieve symptoms, enhance exercise tolerance, prevent/treat exacerbations, improve quality of life, and reduce premature mortality
• Nursing management implementation for COPD involves health promotion strategies like smoking cessation, avoiding pollutants, early detection and treatment of airway diseases, and education on exercise
• Cystic Fibrosis is an autosomal recessive disease characterized by altered function of exocrine glands involving the lungs, pancreas, and sweat glands, with symptoms like recurring lung infections, cough, runny nose, and dietary issues
• Etiology and pathophysiology of Cystic Fibrosis involve mutations in a gene on chromosome 7 affecting the CFTR protein, leading to abnormally thick mucus production that obstructs airways and glands
• Complications of Cystic Fibrosis include difficulty digesting fats and proteins, progressive lung damage, secondary diabetes, chronic sinus infections, respiratory failure, and Cor pulmonale
• Interprofessional care for Cystic Fibrosis aims to promote secretion clearance, control lung infections, provide adequate nutrition, and includes airway clearance techniques, postural drainage, chest physiotherapy, aerosol medications, and lung transplantation