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Understanding of Asthma

FNP, Pathophysiology class, group presentation

Min Jung Hong

on 11 April 2014

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Transcript of Understanding of Asthma

Food Distribution Center
Hunt Points

hospitalization rates in the
two to three times higher
than those in other boroughs (DOE, 2012)
Environmental Commissioner says
freight trucks
are one of the worst air polluters in urban areas.
The Hunts Point Clean Truck Program
: offer rebate incentives for environment-friendly actions.
(NYC Department of Transportation)

Greening Hunt Point Plan:
plant trees and maintain Green Blocks.
(NYC Department of Park & Recreation)

Symptoms of Asthma:

Chest tightness or pain
Shortness of breath
Repeated/persistent coughing
Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu
Nostrils flare open wide when breathing
Have trouble talking/walking
Breathing is hard work
Case study

A 37 y/o African-American woman with a
history of asthma
presents to the ER with
, and
acute shortness of breath
with audible
. Patient has taken her prescribed medications of Cromolyn Sodium and Ventolin at home with no relief of symptoms prior to coming to the ER.
A physical exam revealed the following:
HR 110, RR 40
signs of accessory muscle use
. Ausculation revealed
decreased breath sounds with inspiratory and expiratory wheezing

and patient was coughing up
small amounts of white sputum
. SaO2 was 93% on room air. An arterial blood gas (ABG) was ordered with the following results:
pH 7.5, PaCO2 27, PaO2 75

Asthma Attack?

Non-allergic asthma
Allergic asthma
triggered by inhaling allergens.
Immune system is involved.
Diagnostic Study
Detailed history, physical exam
Pulmonary function tests
Peak flow monitoring
Chest x-ray
Allergy testing
Blood levels of eosinophils
Sputum culture and sensitivity

Diagnosis for asthma
Taking a complete history
Performing a physical exam
Having the patient perform breathing tests
: Test lung function when diagnosing asthma
Allows patient to assess status of his/her asthma
Persons who use peak flow meters should do so frequently
Many physicians require for all severe patients
Long-term asthma control medications
Long-acting beta agonists -
salmeterol (Serevent) and formoterol (Foradil, Perforomist)
Bronchodilator -
theophylline (Theo-24, Elixophyllin)
Inhaled corticosteroids -
fluticasone (Flovent HFA), budesonide (Pulmicort Flexhaler), flunisolide (Aerobid)
Combination inhalers -
fluticasone-salmeterol (Advair Diskus), budesonide-formoterol (Symbicort)
Leukotriene modifiers (oral medications)
-montelukast (Singulair), zafirlukast (Accolate), zileuton (Zyflo) 
Quick-relief (Rescue) medications
Short-acting beta agonists -
albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex)
Bronchodilators -
ipratropium (Atrovent)
Oral and intravenous corticosteroids -
prednisone, methylprednisolone
Allergy medications
Allergy shots (immunotherapy)

Omalizumab (Xolair)
Allergy medications -
oral and nasal spray antihistamines, decongestants, corticosteroid (cromolyn nasal sprays)
open air way and reduce the inflammation daily
Quickly open swollen airways and rescue from
asthma attack
In some cases..
Steps to prepare for inhalation
Priming requirements for various inhalers
less than 50%
What is the patient supposed to do before and during
the follow up appointment
earn your medications
espond to warning signs
mergency Care
F.L.A.R.E. Plan
ollow up with your health-professional
Emergency Department Asthma Discharge Instructions
F.L.A.R.E. Plan:
Emergency Department Asthma Discharge Instructions
ollow up with your doctor
earn your medications
sthma is a chronic disease
espond to warning signs
mergency Care

Treatment Asthma
Question :
Why this patient has breathing problem?

Missed dose
Improper delivery dose
Need new prescription
Fail to control triggers
Appropriate immunization

American Academy of Allergy, Asthma, and Immunology. Retrieved from http://www.aaaai.org
Asthma and Allergy Foundation of America. Retrieved from http://www.aafa.org
Asthma initiative of Michigan.(2011, June). F.L.A.R.E. Plan: Emergency Department Asthma Discharge Instructions. Retrieved from http://www.getasthmahelp.org/flare.aspx
Baren JM, Boudreaux ED, & Brenner BE, & Cydulka RK, & Rowe BH, & Clark S, et al. (2006). Randomized controlled trial of emergency department interventions to improve primary care follow-up for patients with acute asthma.Chest,129(2):257-65.
Can Respir, J. (May-Jun, 2005). Asthma management at discharge from the emergency department: a descriptive study. PubMed,12(4), 219-22. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16003459
Finkel, R., Cubeddu, L., & Clark, M. (2009). Pharmacology. Philadelphia, PA: Lippincott Williams & Wilkins
Lareau, S. C., & Hodder, R. (2012). Teaching inhaler use in chronic obstructive pulmonary disease patients. Journal of the American Academy of Nurse Practitioners, 24(2), 113-120. doi:10.1111/j.1745-7599.2011.00681.x
Mayo Clinic. (Feb. 13, 2014). Treatment and Drugs. Retrieved from http://www.mayoclinic.org/diseases-conditions/asthma/basics/treatment/con-20026992
National Asthma Education and Prevention Program. Retrieved from http://www.nhlbi.nih.gov/about/naepp/
The Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/asthma
Sydeney West of Area Health Services (2005, January). Nurse practitioner clinical practice guidelines for the management of asthma . Retrieved from http://www0.health.nsw.gov.au/resources/nursing/practitioner/pdf/ab_np_guidelines_asthma.pdf

Managing Asthma:
Peak Flow Chart
People with
moderate or severe asthma should take readings:
Every morning
Every evening
After an exacerbation
Before inhaling certain medications
airway obstruction
airway obstruction
High residual lung volume
Wheezing on expiration
low perfusion in alveloli
Exhaustion, accessory muscle use
Abnormal signs and symptoms
Vital sign- HR: 110 and RR:40
Decreased breath sounds with inspiratory and expiratory wheezing
Using accessory muscle for breathing
Coughing up small amount of white sputum
Peak flow: 125

ABG test
pH 7.5, PaCo2 27 : respiratory alkalosis
Pa O2 75 : mild hypoxemia(hypoxia)
Peak Flow : 125

The chief complaint :
acute SOB
with audible
1. Bring all of
your medications
and this plan with you.
2. Write down
your questions
and doctor’s answers.
3. Make an
asthma action plan
for you with your doctor that you can follow every day to keep your asthma under control.
What are
the purposes
of these three categories of asthma medication?
What are the names of such medications?
Quick-relief/Rescue medicine

What are
the next steps
for an asthma patient?
What should you do when the condition is
not under control?
What triggers
your asthma flare-ups?
See a doctor or asthma specialist
to make a plan to take control.
long-term control medicine
every day as ordered by the doctor.
Figure out what makes asthma flare up and try to stay away from these

Breathing in chemicals, dusts, fumes at work, colds or flu, animals, dust, pollen and mold, strong odors, weather, exercise, cigarette & other smoke, medicines,
sthma is
a life-long disease
1. You need to learn about your
asthma action plan
2. Learn how to use the
Peak Flow meter
Write down
peak flow numbers every day in a diary.
Question :
What are
the warning signs
that asthma is getting worse?
• Chest feels tight/chest pain
• Short of breath
• Wheezing
• Repeated/persistent coughing
• Wake up 2 nights in a row with symptoms
• Peak flow is getting low (Low – less than 80%
of best; in
“yellow zone”
. The doctor can prescribe a peak flow meter if needed, so be sure and ask.)
• Keep taking/giving medicines as prescribed and call the doctor.
Question :
When is the emergency care needed for asthma?
Have trouble talking or walking
Are struggling to breathe
Need to use quick-relief medicine
more often than every 4hrs
See your
peak flow dropping
Question: What can you do when he or she has a bad flare-up?
Take your quick-relief medicine and wait 20 minutes
If you do not feel better, take it
again and wait
for 20 more minutes. If you still don’t feel better, take it again and call your doctor or
911 right away.

-> open air way and reduce the inflammation
Long term control medicine
Steroid pills or syrup
Quickly open
swollen airways and rescue from asthma attack
-> can help swelling in the breathing tubes go away
Understanding of Asthma

Minjung Hong
Hyo zin Park
No Mi Bae
Soowon Cho
Minjung Ji
Full transcript