Asthma

• Asthma

  A chronic, reversible (in most cases) obstruction airway disease characterized by inflammation and mucosal edema, increased sensitivity of the airways and airway obstruction (bronchospasm and in some children, excessive, thick mucus)
• Asthma Pathophysiology and Diagnosis

  1. Airways become inflamed

  2. Increased sensitivity of the airways

  3. Triggers like cigarette smoke, allergen, cold air, exercise or viral infections

  4. Immune system overreacts to allergens

  5. Mast cells release chemicals like histamine

  6. Constrict the airways

  7. Excess mucus production

  8. Hard to breathe
• Pharmacological Management of Asthma

  • Drugs which relieve symptoms as they occur, known as 'relievers'
  • Drugs which prevent worsening or progression of the asthma process, known as 'preventers'
• Relievers (Bronchodilators)

  • Administered with inhalers
  • Direct bronchodilator effect
  • Relieve the symptoms of asthma
  • Stimulate beta2 receptors, causing bronchial smooth muscle to relax
  • Block cholinergic receptors, preventing bronchoconstriction
  • Meant for short-term symptom relief
  • Cause bronchodilation
  • Used to prevent or treat an asthma attack
  • Begin working within minutes
  • May remain effective for up to 6 hours
  • Potential side effects include jitteriness and palpitations
• Preventers

  • Have anti-inflammatory properties
  • Generally taken regularly via an inhaler device
  • Inhaled corticosteroids help reduce symptoms and exacerbations by reducing the inflammation in the airways
  • Remain the most effective agents for gaining and maintaining control of asthma in adults and in children with persistent asthma
• Inhaled Corticosteroids

  • Beclomethasone dipropionate HFA
  • Budesonide
  • Fluticasone propionate
  • Ciclesonide
  • Mometasone
• Combination Medications

  • Fluticasone and salmeterol (purple inhaler)
  • Budesonide and eformoterol (red and white inhaler)
  • Beclomethasone and eformoterol (fostaire)
• Asthma triggers


  • Identification of specific triggers that precipitate an attack
  • Removal of as many triggers as possible from the environment
• Peak Flow Meter (PFM) technique


  Correct technique
• Asthma symptom diary


  Maintaining, especially for a child with frequent symptoms
• Asthma medications


  • Drug name
  • Route
  • Purpose (type: controller - long term management or short acting - immediate relief)
  • Dosage
  • Precautions
  • Potential side effects
• Using MDIs with a spacer (holding chamber) or spacer with a mask


  • Proper technique
  • Document adequate return demonstration
• Over the counter (OTC) inhalers


  Can interfere with prescribed therapy
• Sequencing of inhalers


  Bronchodilator inhalers are used 15 min before administration of the steroid inhaler
• Cleaning and care of equipment


  Nebulizer, MDI, or other medication delivery systems
• Early warning signs before an acute asthma attack

  • Fatigue, sneezing, sore throat, itchy/watery eyes, headache, slight tightness in chest, drop in PFM values
• Importance of avoiding contact with infectious individuals, especially those with respiratory infection
• Recommendation that the child receive annual influenza and all age appropriate vaccinations
• When to call the health care provider

  To refill medications
• When to call emergency medical services


  Signs and symptoms of increased respiratory distress