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ASTHMA, Treatments and Management Strategies, respiratory therapist -…

- - - - cellular infiltration
        
        airway remodelling (irreversible airway constriction)
        
        narrowing of airways
        
        bronchoconstriction
        
        neuropeptide release and autonomic nervous system effects
      - vasodilation and increased capillary permeability
        
        impaired mucociliary function, mucus secretion, bronchospasm, vascular congestion, edema, airway wall thickening
        
        bronchial hyperresponsiveness and airway obstruction
      - histamine, bradykinin, PAF, cytokines
- - - - physical examination
      - arterial blood gases (ABGs)
      - health history (medications and exposure to triggers)
      - pulmonary function testing
    - - PEFR > 80%
      - minimize symptoms and prevent exacerbation and attacks
      - limit adverse effects
      - promote activity as tolerated
      - explore treatment and management options
    - - medication management (client and HCP)
        
        learn about management strategies and medication, monitor medication response, take medication regardless of symptom presence
      - health promotion and education
        
        avoid triggers and eat healthy
        
        rapid assessment and treatment of infections
        
        drink at least 2-3 L of fluids/day
        
        daily PEFR measurement
        
        report severe manifestations & seek care
    - - evaluate effectiveness of management strategies and treatment
  - - - physician - helps in diagnosis, management of care and treatment
      - pharmacist - aid in medication and pharmacological therapies required for the client
        
        A pharmacist can help determine pharmacological therapies and can aid if any changes to medication regiment are needed
      - social worker - can help assess the client's access to resources and treatment options and explore any beneficial programs
      - occupational therapist - assessment of ADLs and aid in improving daily activities for the client
      - allergist - performs allergy testing to determine triggers and if asthma is allergy related
    - - use objective means for diagnosis
      - create a relationship between the client, family members, and health care team
      - decrease trigger exposure
      - patient education
      - effective pharmacological therapies
        
        bronchodilators (ex. salbutamol)
        
        β2-adrenergic agonists
        
        anticholinergics (ex. ipratropium)
        
        corticosteroids (ex. fluticasone & prednisone)
        
        leukotriene modifiers (ex. montelukast)
        
        biologics (ex. omalizumab)
      - continuous evaluation of asthma severity and management
      - use of a written action plan
      - regular follow up checkups
- - - - restlessness, exhaustion, confusion
    - - cyanosis, diaphoresis, eczema
    - - wheezing upon expiration, crackles, absence of breath sounds
      - hyper-resonance on percussion
      - use of accessory muscles
      - tachypnea and prolonged expirations
      - intercostal and supraclavicular contractions
    - - tachycardia
      - jugular vein distension
      - hypertension/hypotension
      - premature ventricular contractions
  - - - preferred test for diagnosing asthma, may have reduced FEV1/FVC (less than normal based on age, sex, height, ethnicity)
    - - to measure airway hyper-responsiveness
    - - to determine whether patient has exercise-induced asthma
    - - measures patient’s exhalation, monitored daily according to personal best expiratory flow rate, asthma may cause decreased flow rates
        
        100%- green zone- doing well
        
        80%- yellow zone-caution
        
        70%- red zone- medical alert
        
        50%- red zone- emergency
    - - determine sensitivity to certain allergens
    - - to determine whether there is an infection in lungs and possible treatments