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Chronic Asthma (Treatment (Goals-Reduce the use of short-acting beta 2…
Chronic Asthma
Treatment
Goals-Reduce the use of short-acting beta 2 agonists, maintain normal function and activity, prevent exasperations, minimize the need for emergency care and hospitalizations, prevent loss of lung function, in children prevent loss of lung growth
Reduce exposure to allergens, irritants, pollutants
Consider allergy immunotherapy to reduce symptoms
Consider long-term control medications-long acting beta 2 agonist, should be taken daily, open airways by relaxing smooth muscle around the airways should always be used with inhaled corticosteroids
Treat comorbid conditions- allergic bronchopulmonary aspergillosis, gastroesophageal reflux, obesity, obstructive sleep apnea, rhinitis, sinusitis, stress, and depression
If patient has exercise induced asthma teach them to take treatment before exercise, short acting beta 2 agonist
Corticosteriods-prevent and reduce airway swelling, reduce mucus in the lungs. Most effective long-term control medicines available. Oral corticosteroids-pill or liquid form, used for the treatment of asthma attacks that do not respond to other asthma medications, or for long-term therapy for those with severe asthma,
Combination inhaled medicines- contain both inhaled corticosteriods and inhaled long acting beta agonists.
Biologics-shots or infusions given every few weeks, target a cell or protein in the body to prevent airway inflammation, expensive and should only be used if asthma medications are not working well
Leukotriene modifiers-pill or liquid form, reduces swelling in the airway and relaxes smooth muscle
Cromolyn Sodium-inhaled non-steroid, prevents the airways from swelling when coming in contact with an asthma trigger
Theophyline-tablet, capsule, solution and syrup taken by mouth, opens the airway by relaxing smooth muscle
Pathophysiology
Thickening of the subasement membrane
Airway smooth muscle hypertrophy and hyperplasia
Subepithelial fibrosis
Blood vessel proliferation and dilation
Airway Remodeling
Mucus gland hyperplasia and hypersecretion
Same pathophysiology as acute asthma but systems cause chronic changes in the airways
Clinical Presentation
Chest tightness
Wheezing
Inflammation and narrowing of airway
Cough early in the morning or at night
Shortness of breath
Reduced exercise intolerance
Diagnosis
Assess every 2-6 weeks while gaining control
Assess every 1-6 months to monitor control
Spirometry at least every 1-2 years
Assess every 3 months in step down therapy is indicated
Assess asthma control at every visit
Epidimiology
Severe is considered several times a day having symptoms
Moderate is considered daily symptoms
Mild is considered having symptoms greater than 2 days a week but not daily