# Asthma --- **Asthma** is a [[respiratory system#Restrictive & Obstructive Respiratory Diseases|obstructive respiratory disease]] where an [[inflammation|inflammatory]] response causes [[bronchi|bronchoconstriction]] and an increased production of [[mucous membrane|mucus]] hypersecretion, both of which obstructs airflow and [[alveolar gas exchange]]. It is a chronic disease that can have episodic exacerbations, which presents as increased airway resistance and WOB. Chronic asthma can also cause permanent changes to the tissue of the airway. About 50% of people with asthma have it because their body has a hyperimmune reaction to some sort of irritant, but the other half of the time the cause is unknown. That makes it really difficult to treat because one of the best ways of treating the asthma is by removing the cause of the reaction (like carpets are a big culprit). ![[asthmatic bronchioles.png]] ## Risk Factors Asthma is a disease that predominately effects poor and disadvantaged people, for a lot of reasons. A lot of the risk factors are really [[social determinants of health]], such as: - exposure to airway irritants - such as pollution - who is more likely to live in areas of high pollution? - lower [[social determinants of health|socioeconomic status]] - family history - generational poverty - ethnic/racial disparities - redlining The risk factors for asthma **exacerbations** are: - exposure to airway irritants - fire season - respiratory infections - allergens - pets, carpets, roaches - exercise ## Signs & Symptoms The most common symptoms of an asthma attack are - Cough - Dyspnea - Wheezing - This may disappear if the obstruction worsens, which is a *very bad sign* - Tachypnea (RR >30) - Tachycardia (RR >120) - Be careful, a side effect of rescue inhalers is an increase in heartrate - Chest tightness - Ineffective cough - just dry, airy and not doing anything helpful - Use of accessory muscles/retractions - Apprehension - Tripod positioning - Diaphoresis - Cyanosis - A late sign and bad news ## Diagnostic Tests - chest x-ray - not usually done unless complications are suspected - a skin test for allergens - blood/sputum tests - looking for increased [[eosinophils]] or [[antibody|IgEs]] - ABGs - if they're in the hospital - at risk for [[acidosis|respiratory acidosis]] from hyperventilation initially, and then [[alkalosis|respiratory alkalosis]] from retention of CO2 as an attack continues. - [[pulmonary function tests]] ## Treatment Treatment of asthma typically involves the prevention of exacerbations and the control of symptoms. For people with allergen reactions there can be environmental control measures, such as removing any carpet, using HEPA filters, maybe even finding new homes for pets. (Oh no, a lot of that sounds [[social determinants of health|expensive]]...) - medications - short term, attack rescues - a SABA like **albuterol** (inhaled) - a [[bronchodilators|bronchodilator]] - [[anticholinergics]] like ipratropium if they don't respond to albuterol well - long term management - inhaled [[corticosteroids]] such as **fluticasone** or **beclomethasone** or **prednisone** - make sure to tell people to rinse with water afterwards, and lookout for thrush - a **LABA** like salmeterol - a [[bronchodilators|bronchodilator]] - Methylxanthines like theophyline - PO or IV - but we don't see these much anymore because they have bad side effects and a narrow therapeutic range. ### Peak Flow Monitoring **Peak flow monitoring** is one way of measuring how much someone is able to breathe on a day-to-day basis. The peak expiratory flow rate is measured twice a day, and you use the best of three tries to measure someone's "personal best". Then one's current "zone" is determined based on that personal best. Management depends on the zone someone is in. - green zone: 80-100% of personal best - yellow zone: 50-80% of personal best - red zone: below 50% = EMERGENCY ## Status Asthmaticus **Status asthmaticus** is a prolonged asthma attack that does not respond to routine treatment. It is a medical emergency. Typically caused when a mucus plug compleatly blocks the ariway and leads to hypoxemia and respiratory failure. Treatment involves giving IV meds and O2. One thing you do *not* want to give someone in status asthmaticus is sedatives, as this will slow breathing and we definitely want to avoid that. ## Nursing Considerations Monitor for symptoms AGBs monitoring for decreased CO2 due to hyperventilation Chest PT deep breathing/cough albuterol lowers the apatite, so be on the lookout for malnutrition ___