Asthma 1 Definition Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. The episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment. 2 Do you know … (asthma facts) ●Asthma is one of the most common chronic dias worldwide. ●An increasing prevalence of asthma and incorrect treatment increa the mortality of asthma. 3 Etiology and Pathogenesis (what cau asthma?) (1) Etiology Host factors ∙Genetic predisposition ∙Obesity ∙Sex Environmental factors ( Factors that Exacerbate Asthma) Environmental factors include allergens, respiratory infections, diet, drugs, and exercis. (2) Pathogenesis 变态反应 allergic reaction 气道炎症airway inflammation 气道高反应性airway hyperresponsiveness AHR 神经-受体平衡失调neuroceptor dyquilibrium 4 Clinical findings (1) Symptoms The typical symptoms of asthma are recurrent episodes of cough, wor particularly at night; shortness of breath, chest tightness, wheezing (means there are high-pitched whistling sounds when breathing out, especially in children), and sputum production. The symptoms occur or worn at night or in the early morning, awakening the patient. That is often reversible either spontaneously or with treatment. cough-variant asthma 咳嗽变异性哮喘 exerci-induced bronchoconstriction 运动性哮喘 软件服务合同模板 (2) Physical examination The most common physical finding in asthma is diffusing, expiratory wheezing, an incread respiratory rate and prolonged expiration. 寂静胸（silent chest）:occasionally, in vere asthma exacerbations, wheezing may be abnt owing to verely reduced airflow and ventilation. 5 Laboratory examination (1 )Measurement of lung function PEF↓ FEV1↓ diumal variation in PEF >20% bronchial provocation test :＞20% decrea in FEV1 15 minutes after inhalation of a specific agents or after 6 minutes of exerci. bronchial relaxation test :＞15% increa in FEV1 15 minutes after inhalation of short acting β2 agonist . (2 )Measurement of allergic status Skin tests with allergens or measurement of specific IgE in rum: The prence of allergies increas the probability of a diagnosis of asthma, and can help to identify risk factors that cau asthma symptoms in individual patients. 闸坡大角湾(3) Other laboratory examinations Arterial blood gas analysis Sputum studies Chest X-ray 6 Diagnosis (1) Asthma diagnosis History and patterns of symptoms Physical examination Spirometry to demonstrate reversibility Exclude other caus of wheezing (2) Asthma staging Acute Asthma Exacerbation 急性发作期 Chronic asthma persistent 慢性持续期 Asthma paracmasis 缓解期 7 并发症（ Complication ） Complications of asthma include airway infection, exhaustion, cor pulmonale肺源性心脏病/呼吸衰竭respiratory failure、气胸古诗阅读pneumothorax等 8 Therapy ↗allergen avoidance ↗main curative Medications to treat asthma can be divided into two categories: relievers and controllers. Inhaled glucocorticosteroids are the most effective controller medications currently available. （1） β2-agonist 通过对气道平滑肌表面的β 2 受体的兴奋，舒张气道平滑肌。控制哮喘急性发作的首选药物。 short-Acting β2 -Agonists：5－10分钟起效，维持 4－6孕妇可以吃什么小时。如沙丁胺醇（salbutamol）、特布他林（terbutaline） Long-Acting β2 -Agonists：可维持12小时。如福莫特罗（furmoterol）、沙美特罗（ salmaterol）、班布特罗（bambuterol） （2） Theophylline 抑制磷酸二酯酶，提高平滑肌细胞内的 cAMP 浓度外；刺激肾上腺分泌肾上腺素，增加呼吸肌的收缩；增强气道纤毛清除功能和抗炎作用。 aminophylline氨茶碱 sustained-relea theophylline缓释茶碱（controller） （3） Anticholinergics降低迷走神经的张力，解除支气管痉挛 溴化异丙托品（ ipratropium bromide ）噻托溴铵(tiotropium bromide) （4 ）Glucocorticosteroids ∙controlling airway inflammation ∙decreasing airway hyperresponsiveness systemic glucocorticosteroids：甲基强的松龙methylprednisolone、地塞米松dexamethasone、氢化可的松hydrocortisone、泼尼松prednisone、强的松prednisone. inhaled gulcocorticosteroids(ICS)：倍氯米松（beclomethasone.BDP）、布地奈德budesonide、氟替卡松fluticasone. （5） Sodium Cromoglycate （6）Leukotriene Modifier 扎鲁司特（zafirlukast安可来）、孟鲁司特（montelukast顺尔宁） ↗treatment of Asthma exacerbation The aims of treatment are to relieve airflow obstruction and hypoxemia as quickly as possible, and to plan the prevention of future relaps. Early intervention may lesn the verity and duration of an exacerbation. The primary therapies for exacerbations include, depending on verity, repetitive or continuous administration of an inhaled short-Acting β2 -Agonists, early introduction of systemic glucocorticosteroids to patients with moderate to vere asthma exacerbations , and oxygen supplementation. ↗treatment of asthma paracmasis Depending on the patients’ current level of asthma control and current treatment , each patients is assigned to one of five “treatment steps”. For example, if asthma is not controlled on the current treatment regimen, treatment should be stepped up until control is achieved. If control has been maintained for at least three months, treatment can be stepped down. At each treatment step ,reliever medication should be provided for quick relief of symptoms as needed. At step 2 to 5, patients also require one or more regular controller medications, which keep symptoms and attacks from starting. 9 Nursing diagnosis impaired gas exchange related to incread airway resistance, airway inflammation, and airway spasm ineffective airway clearance related to bronchospasm, ineffective cough, excessive mucus production, tenacious cretions, and fatigue knowledge deficit chairrelated to knowledge deficits of MDIs 10 nursing implemention reduce exposure to risk factors avoid food allergies, lay off alcohol and somking provide comfortable position, such as orthopnea 敷衍了事是什么意思monitoring conditions, especially at night or in the early morning keeping airway clear, and oxygen is given by mask or nasal prongs teach clients effective coughing techniques teach client to breathe deeply through the no and exhale 2-3 times through purd lips decrea the clients’ anxiety and panic teach clients the correct administration of medications, especially how to u inhaler devices and monitoring the side effects. Medicine care ✓glucocorticosteroids Oral candidiasis ,hoarness, irritated throat and dry cough are local adver effects caud by inhalation of corticosteroids. The problems can be reduced or prevented by mouth washing; take oral medicine after meals to reduce stimulation of gastrointestinal. It should never be abruptly discontinued but tapered gradually over time to prevent adrenal insufficient. 画一幅做家务的画✓β2 agonists short-acting inhaledβ2 agonist should be ud only on an as-needed basis at the lowest do and frequency required, not for long-term, regular, single, and large-do u control the drip rate while using salbutamol, and monitor adver systemic effects, such as tremor and tachycardia.文爱文字 ✓methylxanthines the main problem with theophylline is the relatively high incidence of side effects, which include gastrointestinal symptoms, cardiac arrhythmias, low blood pressure, and even death. Side effects can be reduced by careful do lection and monitoring the rum concentration of theophylline. pay attention to concentration and speed while iv.drip ，>10min theophylline administration requires monitoring of its rum concentrations for safe and effective u. liver dia, congestive heart failure, and certain drugs including cimetidine, some quinolones, and some macrolides increa the risk of toxicity. 11 Heath education ⏹knowledge of dia ⏹Identify and reduce exposure to risk factors ✓remove animals from the home, or at least from the sleeping area. ✓stay away from tobacco smoke. patients and parents should not smoke. ✓avoid drugs, foods, and additives, if they are known to cau symptoms. ✓keep the bed simple, wash sheets and blankets often in very hot water. put them in the sun to dry. ✓clo windows and doors and remain indoors when pollen and mold counts are highest. ✓take asthma medicine before doing some activities ⏹lf-monitoring ✓be alert for ugh, chest tightness, wheeze, wake up at night… ✓act fast if an asthma attack starts. ✓get emergency help from a doctor if you donot get better. ⏹drug management ⏹psycho-social guidance |
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