How does an asthma attack present initially?
Later on?
Wheezing, difficulty exhaling, hypoxemic, respiratory alkalosis from hyperventilation, tachypnic
CO2 rises, respiratory acidosis as air trapping worsens, respiratory failure sign
Explain the late-phase response
After recovering from an acute attack, they may have a secondary attack 4-10 hours after
Can be more severe/longer-lasting
What is a baseline like for asthma patients?
They return to baseline-normal respiratory function between attacks
-Goal: stay at baseline at all times
Describe silent chest
A bad sign:
suddenly no longer wheezing: means air is no longer moving
Life-Threatening Asthma Exacerbation
-what is it
-manifestations
Most extreme form of asthma attack
-unresponsive to normal treatment
Hypoxia, hypercapnia, ARF, chest tightness, high SOB, unable to speak, hypotension, bradycardia, cardiac arrest
How is a life-threatening asthma exacerbation treated?
IV magnesium sulfate
-strong bronchodilator
Ventilation
Explain FEV-1
Forced Expiratory Volume in 1 second
-asthmatics have a low value
Explain FEV-1 / FVC ratio
FVC: forced vital capacity: total expiration volume
For asthmatics: the FEV1/FVC is decreased
What is an asthmatic’s residual volume like?
increased
Inhaled Corticosteroids
-list 3
-explain them
-side effects
Fluticasone, Budesonide, Mometasone
Reduce bronchia hyperresponsiveness, block the late-phase response, inhibit inflammation
First line for acute attacks and for maintenance
-most effective treatment for asthma
Easy bruising, decreased bone density, oral yeast infection, dry cough, hoarse
-use spacer and gargle after use
Explain SABA
-albuterol
Short-acting Beta Agonist
-bronchodilator B2-agonist
Albuterol
Effective for acute attacks, does not inhibit late-phase response, is not anti-inflammatory
-rapidly dilates bronchi
Side effects: tremors, anxiety, nausea
Explain LABAs
-Formoterol, Salmeterol
Long-Acting Beta-Agonists
-bronchodilator B2-Agonists
Used with ICS in a combo inhaler
works for 12 hours
Do not use by itself for attacks
Theophylline
Methylxanthine bronchodilator
-weak bronchodilator, mild anti-inflammatory effects
-narrow therapeutic window
Ipratropium
Anticholinergic bronchodilator
-reduces parasympathetic response
-adjunct for severe attacks
Montelukast
Leukotriene modifier
-oral maintenance medication
-not used for acute attacks
Explain Metered Dose Inhalers
-problems
-what should be used?
Hard to coordinate timing, must hold breath for 10 seconds after, must shake beforehand, wait 1-min between puffs, no indication that it’s empty
Use a spacer to give time for each dose
Dry powder inhaler
Simpler than MDI, tracks dosage for you, no coordination necessary
-not all drugs available (albuterol), requires adequate FEV-1
Nebulizers
Mostly an RT responsibility
-converts drugs into inhaled mists
-used for those unable to use MDI
-breathe slowly, hold each inspiration for 2-3 seconds
-clean daily
How long must a patient hold their breath after each puff with an MDI?
10 seconds
Explain Peak Flow Meter use
Helps patients assess severity of their attacks
Green: 80-100% of personal best
Yellow: there is a trigger
Red: <50% of personal best: severe attack!
What is the asthma action plan?
A written set of instructions for the patient to follow depending on their peak flow meter result
