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
Student Course Evaluation Form
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Learning Objectives
Upon completing the course you’ll be able to:
Chapter 1: Definitions
- Explain airway pathology in asthma.
- Describe the relationship of airway pathology to disordered lung function.
- List and explain all forms of airflow imitation in asthma.
- Based on the functional consequences of airway inflammation, provide an operational description of asthma.
Chapter 2: Epidemiology
- Describe the prevalence of asthma based on genetic factors, environmental factors, allergens, and population characteristics.
- Describe the mortality and morbidity of asthma.
- Describe the evolution of asthma from infancy to adulthood.
- Formulate a respiratory health survey questionnaire.
Chapter 3: Risk Factors
- Identify two predisposing factors that lead to the development of asthma.
- Identify four causal factors that lead to the development of asthma.
- Identify five contributing factors that lead to the development of asthma.
- Identify six factors that exacerbate asthma.
Chapter 4: Mechanism of Asthma
- Discuss the mechanism of airway inflammation in asthma.
- Explain how nonspecific stimuli provoke reflex bronchoconstriction.
- Describe four characteristics symptoms of asthma.
- List four factors that may contribute to airflow limitation in asthma.
- Describe nocturnal asthma.
Chapter 5: Diagnosis and Classification
- List five symptoms that would lead to a clinical diagnosis of asthma.
- Formulate five questions of the patient in considering the diagnosis of asthma.
- Describe how measurements of airflow limitation, its reversibility and its variability can help in establishing a diagnosis of asthma.
- Describe two methods (FEV1 and FVC) used to assess the level of airflow limitation.
- Describe the additional factors to be considered in the diagnosis of childhood asthma in the elderly, occupational asthma, seasonal asthma, and cough variant asthma.
- Explain the classification of asthma on the basis of etiology, severity and pattern of airflow limitation.
- Describe clinical features before treatment and daily medication required to maintain control of asthma classified by its severity.
Chapter 6: Prevention
- Discuss the goal of primary prevention of asthma.
- Discuss seven primary prevention strategies for asthma.
- Explain how the domestic mite allergen is a major causal risk factor for asthma.
- Describe five future programs for the primary prevention of asthma.
Chapter 7: A Six-Part Asthma Management Program
- List seven goals for successful management of asthma.
- Educate patients to develop a partnership in asthma management.
- Assess and monitor asthma severity with measurements of symptoms and measurements of lung function.
- Interpret PEF measurements for management of asthma.
- Describe six nonpharmacological secondary prevention measures to avoid or control asthma triggers.
- Establish a medication plan for long-term management of asthma using controller medications and reliever
medications. - List eight parameters that would define control of asthma.
- Describe a four-step treatment approach to the long term management of asthma.
- Ask six questions of the asthma patient to establish the diagnosis and classify the severity of asthma.
- Describe the four-step treatment approach for infants and young children in the management of asthma.
- List eight objectives for the control of asthma in infants and young children.
- List four categories of patients who are at high risk of asthma-related death.
- Classify 11 symptoms into mild, moderate and severe exacerbations of asthma.
- Describe treatment for home management of asthma exacerbations.
- Describe in a flow chart format the management of exacerbation of asthma in a hospital environment.
- List eight factors that would indicate the need for close and continuous supervision of the asthma patient in a hospital.
- List three criteria for admitting the asthma patient to the intensive care unit.
- List nine criteria to determine if the patient can be discharged from continuous supervision in a hospital.
- Explain special considerations required in managing asthma in relation to pregnancy, physical activity, surgery, occupational asthma, and aspirin-induced asthma.
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.
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