Download Asthma

Asthma
Triggers and Health
Promotion
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Significance
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
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Asthma affects about 20 million
Americans
Adult females have a 30% greater
prevalence of asthma than males
Female death rate 42% greater than
males
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers
 Bring on symptoms of asthma
 Different from person to person
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers (cont’d)


Asthma cannot be cured, but can be
managed
Goal in asthma - minimize exposure to
triggers
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Allergens

About 40% of cases are related to an
allergic response
 May be seasonal or year round
depending on exposure to allergen
 Nonseasonal forms of asthma may be
year round (perennial)


Related to allergens such as dust mites, molds,
animals
Cockroaches
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens

Dust mites like warm places
 Bedding, upholstered furniture,

carpeting, and stuffed toys
Control dust and dust mites
 Put mattresses and pillows in special
allergen-proof covers
 Wash bedding every week in hot water
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)

Control dust and dust mites
 Remove dust collectors from the
bedroom
 Dust woodwork and wash curtains
often
 Use a damp mop on floors instead of
sweeping
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)

Control dust and dust mites (cont’d)
 Vacuum carpets/rugs weekly
 Avoid using humidifiers and use
dehumidifiers in damp parts of the
house
 Replace air conditioner and furnace
filters monthly
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)

Control mold indoors
 Basements, kitchens, and bathrooms
should be kept as clean and dry as
possible.
 Humidifiers and vaporizers should be
avoided.
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)

Control mold outdoors (cont’d)
 Stay inside in air conditioning on damp,
windy days
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)

Control mold
 Keep bathroom dry by using an exhaust
fan or dehumidifier
 Clean sinks, tubs, and showers with
bleach solution (1 part bleach, 3 parts
water)
 Limit house plants
 Clean spacers and nebulizers often
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)

Control pollen
 Weather reports tell when pollen counts
are high
 Pollen levels can be obtained on
Internet by going to sites such as www.
Pollen.com
 Pollen counts are lower in the evening
so that is a better time to go outdoors
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Allergens (cont’d)

Control pollen (cont’d)
 During allergy season, use air
conditioning instead of opening
windows
 Change the air conditioner filter
monthly
 Shower or bathe after being outdoors
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Pets
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Keep pets out of bedroom and living areas
Brush and wash pets weekly
Use feather pillows
Cat litter emptied by nonallergic person
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Exercise

Induced or exacerbated after exercise
 Typically occur after vigorous exercise
 Pronounced with exposure to cold air
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Exercise
 Medications to promote bronchodilation
 10-20 minutes before exercise
 Cromolyn (Intal), nedocromil (Tilade), β2-
agonists
 Warm up 2-3 minutes by exercising slowly

at first
Limit exercise if ill or if the weather is cold
and dry
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Air Pollutants

Can trigger asthma attacks
 Cigarette or wood smoke
 Vehicle exhaust
 Elevated ozone levels
 Sulfur dioxide
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Health Promotion - Air Pollutants

Ozone alert days
 Noted in newspaper
 Minimize outdoor activity during these
times
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Smoking
 Do not allow smoking in home or car
 Do not use wood burning stoves or

fireplaces
Avoid campfires
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Occupational Factors

Most common form of occupational
lung disease
 Exposure to diverse agents
 Arrive at work well, but experience a
gradual decline during day
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion – Occupational Factors

Nurse needs to obtain a health history
 Assess if symptom-free when not at work

Use masks and proper ventilation
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Respiratory Infection

Major precipitating factor of an acute
asthma attack
 ↑ inflammation hyperresponsiveness of
the tracheobronchial system
 Viruses cause asthma by activating
immune system
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Nursing Management
Health Promotion - Infections
 Avoid people with colds and flu
 Get a yearly flu shot
 Wash hands often
 Eat well
 Get plenty of sleep
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Nose and Sinus Problems

Allergic rhinitis and nasal polyps
 Large polyps are removed
 Sinus problems are usually related to
inflammation of the mucous membranes
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Drugs and Food Additives

Asthma triad: nasal polyps, asthma,
and sensitivity to aspirin and NSAIDs
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Drugs and Food Additives (cont’d)

Symptoms related to asthma triad
 Wheezing develops in about 2 hrs
 Rhinorrhea, congestion, tearing
 Facial flushing, GI symptoms

Need to avoid aspirin and NSAIDs
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Drugs and Food Additives (cont’d)
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β-blockers may trigger asthma
 Propanolol (Inderal)
 Timolol (Timoptic)

Inhibit adrenergic stimulation of
bronchioles and prevent
bronchodilation
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Drugs and Food Additives (cont’d)

Sulfites may trigger asthma
 Used in dried fruits, wine, beer, shrimp,
and salad bars
 Used as preservative in eye solutions, IV
corticosteroids, inhaled bronchodilators
 Can cause breathing difficulty for many
people with asthma
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Drugs and Food Additives (cont’d)

Food allergies may cause asthma
symptoms
 Avoidance diets
 Rare in adults
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Gastroesophageal Reflux Disease
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>75% of people with asthma
experience GERD
Those with severe asthma more likely
to have GERD
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Gastroesophageal Reflux Disease (cont’d)
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Chronic backward flow of stomach
acid into esophagus
Causes burning sensation called
heartburn
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Gastroesophageal Reflux Disease (cont’d)

Exact mechanism causing asthma is
unknown
 Reflux of acid could be aspirated into
lungs, causing vagal stimulation and
bronchoconstriction
 Treated with H2-histamine blockers and
proton pump inhibitors
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Health Promotion - GERD
 Raise head of bed by 6 inches to allow
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gravity to keep contents in stomach
Eat meals at least 3-4 hours before lying
down, and avoid bedtime snacks
Eat smaller meals
Maintain healthy weight to eliminate intraabdominal pressure caused by extra
pounds
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Health Promotion - GERD (cont’d)
 Limit fatty foods, chocolate, peppermint,
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coffee, tea, colas and alcohol - all of which
relax the lower esophageal sphincter (LES)
Limit tomatoes and citrus fruits or juices,
which contribute additional acid that can
irritate the esophagus
Do not smoke, which also relaxes the LES
Wear loose belts and clothing
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Triggers of Asthma
Emotional Stress

Psychological factors can worsen the
disease process
 Attacks can trigger panic and anxiety
 Extent of effect is unknown
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Case Study

A 30-year-old African America woman
comes to the emergency department
(ED) with severe wheezing, dyspnea,
and anxiety
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Case Study (cont’d)

Her history indicates she
 had a recent cold that did not resolve
 had taken a new job at a dry cleaners
and laundromat
 was having regurgitation of food after
eating which she related to the stress
from her recent divorce
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Case Study (cont’d)

Her history indicates:
 she was upset that her children had just
brought home a stray cat
 she did not know if she was allergic to it
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Case Study
Health Promotion Strategies

Teach patient to identify and avoid
possible triggers
 Upper respiratory tract infection
 Work environment
 Stress and GERD
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.
Case Study
Health Promotion Strategies (cont’d)
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Teach patient to identify and avoid
possible triggers (cont’d)
 Cat??

Review medication regimen
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.