Asthma Presentation

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Asthma Presentation By BC

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What is Asthma?

• Chronic inflammatory disorder of the bronchi
• Antigen-antibody hypersensitivity reaction
• IgE antibody production
• Mast cell degranulation
• Larger inflammatory response including release of
  histamine, prostaglandins and leukotrienes
• Bronchi are infiltrated by neutrophils,
  eosinophils and lymphocytes (McCance Huether,
  2006)

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• Bronchial airways
• Vasodilation with vascular congestion in
  bronchial walls, mucus secretion, impaired
  mucociliary function and bronchospasm
• Thickened bronchi reduces lumen size resulting in
  airflow limitation
• Air trapping in alveoli can result impaired lung
  function (McCance Huether, 2006)
• http//www.mayoclinic.com/health/asthma/mm00001

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Prevelance/History

• Two-fold increase in asthma cases over the last
  20 years (Burns, 2007).
• Prevelance rates in Canadian adults are 8.4
  (Chen, Johansen, Thillaiampalam Sambell, 2005)
• Prevelance rates in Canadian children are highest
  in 13 to 14 years old at 12.5 (Chen et al.,
  2005)

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• Females have slightly higher incidence then males
• Deaths from asthma exacerbation in 1985 was 25
  per 1 million people and in 2001 decreased to 12
  per 1 million people (Chen et al., 2005).
• Linked to allergies, dermatitis and rhinitis
  (Burns, 2007).

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Causes/triggers

• Familial predisposition genetic
• Non-allergic triggers (non-atopy)
• cigarette smoke, poor air quality, severe cold
  and hot temperatures, perfume and hair spray
• Prenatal and post natal smoking causing childhood
  asthma
• Chemicals, occupational exposure to irritants ie.
  Particles fumes
• Exercise
• Medications ie. ASA, beta blockers
• Hormone changes in women
• Infections such as respiratory viruses (Cheers,
  2004 Asthma Society of Canada, 2010)

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Causes/triggers continued

• Allergic triggers (atopy)
• Dust mites, food, mold, pollen, animal dander,
  feathers, latex, drugs
• Eczema and rhinitis often accompanies allergies
• Exacerbations can be seasonal (Cheers, 2004
  Asthma Society of Canada, 2010).
• Triggers can be inhaled, ingested, injected, or
  absorbed.

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Symptoms

• Wheezing (cardinal sign) from bronchial spasm and
  airflow resistance
• Chest tightness shortness of breath
• Increased respiratory rate (hyperventilation)
• Accessory muscles used (sternocleidomastoid)
• Increased heart rate anxiety
• Bronchial mucus, coughing
• Air trapping in alveoli (McCance Huether, 2006
  Burns, 2007 Cheers, 2004).

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Symptoms ...continued

• Decreased lung function
• Children same as above plus stridor, tripod
  position, nasal flaring, neck muscles (Touzin,
  Queyrens, Bussieres, Languerand, Bailey
  Laberge, 2008)
• Initial attack/early phase usually peaks in 30
  minutes lasts about 1 hour followed by a late
  phase in 4-12 hours can be more severe (Burns,
  2008)

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Status Asthmaticus

• Severe and rare form of asthma exacerbation
• Severe bronchospasm work of breathing increases
  5-10 times normal
• Pneumothorax common
• Hypoxemia with cyanosis
• Respiratory acidosis
• Silent chest
• Can be fatal

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Treating Asthma

• Avoid cause/triggers allergy treatment
• Controller medication
• Corticosteroids
• Long-acting bronchodilators (LABA)
• Combination inhalers
• Leukotriene receptor antagonists
• Oral corticosteroids
• IgE blockers

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• Rescue inhalers ie. Ventolin /- atrovent
• Proper inhaler technique
• Nasal sprays if rhinitis
• Hospital care
• Oxygen
• Aerosol inhalation
• IV steroids
• Ventilator support (ie. status asthmaticus)

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Future Research

• Hygiene hypothesis
• Gene identification ie. ORMDL3
• Risk reduction, exposure, workplace safety
• Understanding the increase in cases (Subbarao,
  Mandhane Sears, 2009 McCance Huether, 2006).

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References

• Asthma Society of Canada (2010). Asthma.
  Retrieved from http//www.asthma.ca
• Burns, D. (2007). Management of patients with
  asthma and allergic rhinitis. Primary Health
  Care, 17(5), 40-47.
• Cheers, G. (2004). The Encyclopedic Atlas of the
  Human Body. Vancouver, BC Raincoat Books.
• Chen, Y., Johansen, H., Thillaiampalam, S.
  Sambell, C. (2005). Asthma. Health Reports
  Statistics Canada, 16(2), 43-46.

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References continued....

• McCance, K. Huether, S. (2006).
  Pathophysiology the Biologic Basis for Disease
  in Adults and Children (5th ed.). St louis, MI
  Elsevier Mosby.
• Subbarao, P., Mandhane, P. Sears, M. (2009).
  Asthma epidemiology, etiology and risk factors.
  Canadian Medical Association, 181(9), 181-191.
  Doi10.1503/cmaj.080612.
• Touzin, K., Queyrens, A., Bussieres, J.,
  Languerand, G., Bailey, B. Laberge, N. (2008).
  Management of asthma in a pediatric emergency
  department. Canadian Journal of Respiratory
  Therapy, 44(5), 22-26.