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Foundation and Prevention of

Asthma Exacerbations
BRAD KING, RRT

Lesson Goal

To identify what triggers an

asthma episode and how to avoid it


or eliminate it entirely.

Learning Objectives
The Healthcare provider will define asthma. (cognitive

knowledge)
The Healthcare provider will describe the four main
symptoms of an asthma attack. (psychomotor perception)
The Healthcare provider will distinguish between irritants,
allergens and physical conditions that trigger an asthma
attack. (cognitive analysis)
The Healthcare provider will give examples of triggers in
the home, outdoor triggers, food allergens, drug and
chemical reactions and occupational triggers. (cognitive
comprehension)

What is Asthma?

Asthma is a chronic, inflammatory,

obstructive, non-contagious airway


disease with varying levels of severity
and is characterized by exacerbations.

Asthma Facts
Approximately 22.9 million Americans currently

have asthma. Each year, 30.5 million prescriptions


are written for asthma medication.
That is $30 billion being spent to treat one disease.
Despite disease awareness and availability of
treatment people continue to die from the disease.
The rate of death is higher in women than men.
Adults are more likely to die from asthma than
children.

Lung Anatomy

Conducting Airway Tissue

Pathophysiology of an Asthma Attack

Airway Remodeling

Types of Asthma

Acute asthma
Chronic asthma
Status asthmaticus
Exercise induced asthma
Nocturnal asthma

Symptoms of Asthma

Shortness of breath (dyspnea)


Chest tightness
Coughing
Wheezing

Asthma Triggers

The airways in an asthmatic patients lungs

are always somewhat inflamed. When these


airways are exposed to irritants or allergens,
the airways are triggered and lung changes
associated with asthma begin.
Irritant
Allergen

Asthma Triggers
Irritants
Include

perfumes, cleaning products, tobacco or


wood smoke, chemicals, air pollution, and
aerosol sprays.
Allergens

Include

animal dander, dust mites, cockroaches,


mold, mildew, grass, weed and tree pollen, and
dust.

Triggers in the Home

Smoking
Dust and dust mites
Animal dander
Molds

Checkpoint
A 45 year old woman calls a health care provider after

experiencing an exacerbation of her asthma. The health care


provider asks the patient to describe what precipitated her
symptoms. She states I was outside doing spring weeding in
my flower garden when I started coughing and wheezing. I
had to stop working and use my inhaler. the health care
provider should inform the patient that her symptoms are
most likely caused by
A. Ragweed exposure
B. Industrial pollution
C. Allergic rhinitis
D. Aspergillus fumigatus

Outdoor Allergens - Pollens

Trees
Grasses
Weeds

Checkpoint
A 34 year old female with well controlled severe

persistent asthma visits the clinic. She complains


that when she goes outside in the afternoon to work
in her garden, she frequently has to use her albuterol
inhaler for relief. This problem is most likely due to
A. Dander
B. Pollen
C. Pollution
D. Cockroaches

Food Allergens
Specific foods
MSG
Tartrazine (yellow dye #5; FD&C

yellow, #5)
Sulfites

Checkpoint
An individual with food allergies is having dinner

with some business associates at a local restaurant.


He orders grilled chicken, broccoli, fresh bread, and
wine. Which of these items would most likely trigger
an asthma attack?
A. Grilled Chicken
B. Broccoli
C. Fresh bread
D. Wine

Drug and Chemical Reactions

Aspirin/NSAIDS
Non-Selective Beta Blockers
Contraceptive pills
Omega3 oils

Asthma Triggers

Case Study
A 25-year-old male presenting to the ED in severe

respiratory distress. Patient states his symptoms


started about 15 minutes into mowing his lawn.
Physical examination revealed a very anxious well
developed male in acute respiratory distress. Vital
signs were as follows: BP 137/87, HR 115, RR 35,
SpO2 93% on ambient O2, BS coarse wheezing on
expiration. X-ray displayed increased
anteroposterior diameter, translucent lung fields
without alveolar consolidation.

Case study
After examination the physician orders oxygen

therapy, aerosolized medication therapy, and IV


corticosteroids. 45 minutes following treatment
administration, the patients overall status improved
significantly. The physician suggested the health care
provider to instruct the patient how to reduce the
instance of asthma exacerbations in the future. How
would you approach the patient and discuss
eliminating asthma triggers?