Category:

Asthma

Course Outline

  • Airway pathology in asthma; pathological features of asthma death.
  • Relationship of airway pathology to disordered lung function: airway hyperresponsiveness.
  • Airflow limitation: acute bronchoconstriction; swelling of the airway wall; chronic mucus plug formation; airway wall remodelling.
  • Definition of asthma: mechanisms underlying the definition of asthma.

Prevalence:

  • Defining populations: affluent populations; partly affluent populations; nonaffluent populations; migrants;
  • Defining countries: developed country; developing country.
  • Defining asthma for epidemiological studies measurements of airway hyperresponsiveness.
  • Evaluation of etiological factors.

Mortality of asthma

  • Asthma deaths in 5- to 34-years olds.
  • Morbidity: Quality of life, hospital admissions.
  • Natural history of asthma-Infancy, Childhood, Adulthood.
  • Research questions, needs assessment checklist for health authorities.
  • Risk factors involved in the development of asthma

Predisposing Factors

  • Atopy and inheritance of asthma.
  • Genetic control of IgE synthesis.
  • Genetic control of the immune response,
  • Race and asthma.
  • Causal factors
  • Indoor allergens- domestic mites, animal allergens.
  • Outdoor allergens- pollens, fungi, occupational sensitizers.
  • Drugs and food additives.
  • Contributing factors
  • Smoking-passive smoking, active smoking, air pollution.
  • Outdoor pollutants, indoor pollutants.
  • Viral respiratory infections.
  • Small size at birth.
  • Diet. Parasitic infections.

Risk factors that cause asthma exacerbations: Triggers.

  • Allergens. 
  • Air pollutants. 
  • Exercise and hyperventilation.
  • Weather changes. 
  • Sulfur dioxide. 
  • Foods, additives, drugs. 
  • Extreme emotional expression.

Other factors that may exacerbate asthma.

  • Airway inflammation in asthma
  • Immunologic mechanisms. Inflammatory mediators, IgE-dependent, T-lymphocyte-dependent mechanisms.
  • IgE-independent, T-lymphocyte-dependent mechanisms.
  • Adhesion molecules. Constitutive cells.
  • Neural control of airways.

Asthma symptoms:

  • Cough, chest, tightness, wheezing, and dyspnea.

Airflow limitation in asthma

  • Factors that contribute to airflow limitation in asthma, including direct and indirect (neural) contraction of
    smooth muscle, edema, mucus plug formation, and airway wall remodeling.
  • Being awakened at night by cough, wheeze or breathlessness, or experiencing chest tightness at night or first thing in the morning is characteristic of asthma.

Clinical diagnosis:

  • History and measurement of symptoms
  • Physical examination
  • Measurements of lung function
  • Measurements of allergic status
  • Differential diagnosis of obstructive airway disease

Always think

  • Is obstruction localized or generalized.
  • Measurements of lung function

Childhood asthma

  • cystic fibrosis;
  • recurrent milk inhalation;
  • primary ciliary dyskinesia syndrome;
  • primary immune deficiency;
  • congenital heart disease;
  • congenital malformation causing narrowing of intrathoracic airways; and
  • foreign body aspiration.
  • Asthma in the elderly.
  • Occupational asthma.
  • Seasonal asthma.
  • Cough variant asthma.

Classification of asthma

  • Etiology; severity.
  • Time trends of airflow limitation
  • Severe persistent;
  • moderate persistent
  • mild persistent intermittent.
  • Inhaled corticosteroid and long-acting bronchodilator; inhaled short-acting B2-agonist.
  • Prevent development of the condition of asthma.

Primary prevention strategies:

  • Indoor Environments
  • Tobacco Smoking
  • Outdoor Environments
  • Workplace Environments
  • Small Size at Birth
  • Infections
  • Nutrition and Diet

Goals for successful management of asthma

  • Achieve and maintain control of symptoms
  • Prevent asthma exacerbations
  • Maintain pulmonary function as close to normal levels as possible
  • Maintain normal activity levels, including exercise.
  • Avoid adverse effects from asthma medications
  • Prevent development of irreversible airflow limitation
  • Prevent asthma mortality.

Avoid or control asthma triggers:

  • Avoid or control asthma triggers: nonpharmacological secondary prevention
  • Environmental control measures-domestic mites, animal allergens, cockroach allergen, fungi.
  • Avoidance of outdoor allergens
  • Avoidance of indoor air pollutants
  • Avoidance of outdoor air pollutants
  • Avoidance of occupational exposure
  • Food avoidance
  • Avoidance of certain drugs
  • Vaccination
  • Specific immunotherapy

Establish diagnosis

  • Ask patient or parents: does the patient have?
  • Recurrent attacks of wheezing?
  • Troublesome cough or wheeze at night or early in the morning?
  • Cough or wheeze after exercise?
  • Cough, wheeze, or chest tightness after exposure to airborne allergens or pollutants?
  • Colds that “go to the chest” or take more than 10 days to clear up?
  • Antiasthma medicine?
  • How frequently does the patient take it?

Criteria for admission to intensive care unit:

  • A lack of response to initial therapy in the emergency department and/or rapidly worsening asthma.
  • Presence of confusion, drowsiness, other signs of impending respiratory arrest, or loss of consciousness.
  • Impending respiratory arrest.

Outcome control of asthma

  • Minimal (ideally no) chronic symptoms, including nocturnal symptoms
  • Minimal (infrequent) episodes
  • No emergency visits
  • Minimal need for prn B2-agonist
  • No limitations on activities including exercise
  • PEF circadian variation <20%
  • (Near) normal PEF
  • Minimal (or no) adverse effects from medicine

Severity of asthma exacerbations

  • Breathless.
  • Talks in sentences.
  • Alertness.
  • Respiratory rate.
  • Accessory muscles and suprasternal retractions.
  • Wheeze.
  • Pulse/min.
  • Pulsus paradoxus.
  • PEF.
  • PA2 (on air).
  •  SAO2% (on air)

Special considerations:

  • Pregnancy
  • Surgery
  • Physical activity
  • Rhinitis, sinusitis, and nasal polyps
  • Allergic rhinitis
  • Sinusitis
  • Nasal polyps
  • Occupational asthma
  • Respiratory infections
  • Gastroesophageal reflux
  • Aspirin-induced asthma

Learning Objectives

Upon completing the course you’ll be able to:

Chapter 1: Definitions

  1. Explain airway pathology in asthma.
  2. Describe the relationship of airway pathology to disordered lung function.
  3. List and explain all forms of airflow imitation in asthma.
  4. Based on the functional consequences of airway inflammation, provide an operational description of asthma.

Chapter 2: Epidemiology

  1. Describe the prevalence of asthma based on genetic factors, environmental factors, allergens, and population characteristics.
  2. Describe the mortality and morbidity of asthma.
  3. Describe the evolution of asthma from infancy to adulthood.
  4. Formulate a respiratory health survey questionnaire.

Chapter 3: Risk Factors

  1. Identify two predisposing factors that lead to the development of asthma.
  2. Identify four causal factors that lead to the development of asthma.
  3. Identify five contributing factors that lead to the development of asthma.
  4. Identify six factors that exacerbate asthma.

Chapter 4: Mechanism of Asthma

  1. Discuss the mechanism of airway inflammation in asthma.
  2. Explain how nonspecific stimuli provoke reflex bronchoconstriction.
  3. Describe four characteristics symptoms of asthma.
  4. List four factors that may contribute to airflow limitation in asthma.
  5. Describe nocturnal asthma.

Chapter 5: Diagnosis and Classification

  1. List five symptoms that would lead to a clinical diagnosis of asthma.
  2. Formulate five questions of the patient in considering the diagnosis of asthma.
  3. Describe how measurements of airflow limitation, its reversibility and its variability can help in establishing a diagnosis of asthma.
  4. Describe two methods (FEV1 and FVC) used to assess the level of airflow limitation.
  5. Describe the additional factors to be considered in the diagnosis of childhood asthma in the elderly, occupational asthma, seasonal asthma, and cough variant asthma.
  6. Explain the classification of asthma on the basis of etiology, severity and pattern of airflow limitation.
  7. Describe clinical features before treatment and daily medication required to maintain control of asthma classified by its severity.

Chapter 6: Prevention

  1. Discuss the goal of primary prevention of asthma.
  2. Discuss seven primary prevention strategies for asthma.
  3. Explain how the domestic mite allergen is a major causal risk factor for asthma.
  4. Describe five future programs for the primary prevention of asthma.

Chapter 7: A Six-Part Asthma Management Program

  1. List seven goals for successful management of asthma.
  2. Educate patients to develop a partnership in asthma management.
  3. Assess and monitor asthma severity with measurements of symptoms and measurements of lung function.
  4. Interpret PEF measurements for management of asthma.
  5. Describe six nonpharmacological secondary prevention measures to avoid or control asthma triggers.

To assess the effectiveness of the course material, we ask that you evaluate your achievement of each learning objective on a scale of A to D (A=excellent, B=good, C=fair, D=unsatisfactory). Please indicate your responses next to each learning objective and return it to us with your completed exam.

  1. Establish a medication plan for long-term management of asthma using controller medications and reliever medications.
  2. List eight parameters that would define control of asthma.
  3. Describe a four-step treatment approach to the long term management of asthma.
  4. Ask six questions of the asthma patient to establish the diagnosis and classify the severity of asthma.
  5. Describe the four-step treatment approach for infants and young children in the management of asthma.
  6. List eight objectives for the control of asthma in infants and young children.
  7. List four categories of patients who are at high risk of asthma-related death.
  8. Classify 11 symptoms into mild, moderate and severe exacerbations of asthma.
  9. Describe treatment for home management of asthma exacerbations.
  10. Describe in a flow chart format the management of exacerbation of asthma in a hospital environment.
  11. List eight factors that would indicate the need for close and continuous supervision of the asthma patient in a hospital.
  12. List three criteria for admitting the asthma patient to the intensive care unit.
  13. List nine criteria to determine if the patient can be discharged from continuous supervision in a hospital.
  14. Explain special considerations required in managing asthma in relation to pregnancy, physical activity, surgery, occupational asthma, and aspirin-induced asthma.

Customer Comments

“The course is over all excellent, very professional.”  –  T.C., Poway, CA

“Wonderful course. I had a special interest in this information as I have two children with asthma.”  –  L.B., Chino Hills, CA

“Very appropriate pertaining to NIH guidelines for practice. Well done!”  –  A.S., Lake Forest, CA

“Extremely comprehensive–can be a very useful tool for those clinicians dealing hands on with asthma patients on a frequent basis.”  –  C.W., Palo Alto, CA

“Because I have ASTHMA & also a grandchild suffers ASTHMA, I found this extremely educational, informative and helpful.”  –  D.K., Templeton, CA

“Very informative & helpful–were pass informative to family (son-in-law) has severe asthma & needs is encouraged to learn more.”  –   S.G., San Francisco, CA

“Very good course–content with great adherence to NIH guidelines.”  –  S.W., Hudsonville, MI

“Well done! Up date information! Now I have a great reference book!” –  J.L.M., RN, CA

“Thank you! Very well done and informative! Wonderful worksheets to help teach patients.” – L.J.R., RN, CA