Summary NSG 202 Asthma and COPD Study Guide

Asthma and COPD
Chapter 28
Describe the etiology, pathophysiology, clinical manifestations, and collaborative care of
asthma and COPD.
 Asthma: Chronic inflammatory disorder of the airways that leads to recurrent episodes of
wheezing, breathlessness, chest tightness, and cough; Associated with variable episodes
of airflow obstruction, but is usually reversible and have normal lung function between
exacerbations; smaller airway r/t to bronchospasm and thick mucus
 Etiology (Risk factors)
 Genetics (Male gender is a risk factor in children, but not adults)
 Development of allergic response to common allergens
 Immune response
 Sinusitis, allergic rhinitis, viral URI
 Less chance of developing asthma if exposed to certain infections
early in life, use few antibiotics, exposed to other children, or live
in rural setting with pets.
 Allergens (indoor/outdoor)
 Furry animals, fungi, pollen, molds, cockroaches
 Exercise (EIA)
 After vigorous exercise
 Symptoms when exposed to cold, dry air
 Air pollutants
 Cigarette smoke, wood smoke, vehicle exhaust, climatic changes
 Occupational Factors
 Agricultural, baker, hospital worker, plastics manufacturer,
beautician, etc.
 Resp. tract infections (viral)
 Increase narrowing of airway hyperresponsiveness, increase
inflammatory cell accumulation, and edema of airway walls
 Nose/Sinus problems (hx of allergic rhinitis)
 Acute or chronic problems can worsen asthma
 Drugs
 Aspirin, NSAIDS, Beta blockers, and ACE inhibitors
o ASA and NSAIDs  wheezing within 2 hrs
 Tartrazine (yellow dye no. 5), sulfiting agents (preservatives and
sanitizing agents and in fruits, beer, and wine)
o Asthma exacerbation can occur after use of sulfite-
containing preservatives (topical ophthalmic solutions, IV
corticosteroids, and some inhaled bronchodilators)
 GERD
 Reflex can trigger bronchoconstriction  aspiration
 Asthma meds may worsen GERD symptoms (Beta agonsits)
 Psychologic factors
 Stress, extreme emotional expressions (crying, laughing, anger,
fear)  hyperventilation and hypocapnia  airway narrowing
 Pathophysiology (541)

, Clinical Manifestations (542)
 Wheezing, cough, dyspnea, chest tightness, accessory muscle use, position
to max airflow (tripod position)
 dry or productive cough in early AM or after laughing or
playing sports
 Prolonged expiration (1:3 or 1:4; the normal is 1:2) - remember this
question on the PowerPoint - -1:3 would be expected for a patient with
asthma
 Nocturnal awakenings r/t to symptoms is used as an indicator for severity
of asthma. Symptoms can interfere with ADLs
 Findings on examination
 Wheezing, runny nose, swollen nasal passages, and nasal
polyps can be present. Eczema and hives on skin.
 Classification of asthma (542)
 Table 28-2 - - don’t need to memorize. Just know that these are the levels
for asthma
 Complications (543)
 Status asthmaticus, Rib fracture (rare), atelectasis, pneumothorax,
pneumonia
 Status asthmaticus – prolonged attack, does not respond to
bronchodilators, and range from mild-severe.
 Diagnostic studies
 Hx – GERD, COPD, HF, vocal cord dysfunction all associated with
wheezing and cough, so determine if these are causing exacerbations
 Pulmonary function tests (PFT)
 PEFR – compare with pts. Own previous best measurements
 Spirometry – normal between attack, but decrease in forced vital capacity
(FVC) – look at normal values in chapter 25
 Stop bronchodilator meds 6-12 hrs before test
 Bronchodilators can be taken before or after test to determine
reversibility of airway obstruction
 (+) response to bronchodilator = increase > 200 mL and
increase of >12% between pre-administration and post-
administration values

,  Chest X ray - - show hyperinflation or if caused by foreign pathogens (
 Allergy skin test – (+) test doesn’t mean allergen is causing symptoms and
(-) test doesn’t mean asthma is r/t to allergen
 Eosinophils and IgE – shows increase
 Pulse ox
 ABGs – pH (7.35-7.45), PaCo2 (35-45), HCO3 (22-26)
 RBCs
 Bronchoscopy
 Nitric oxide levels -- increased
 FENO determines if asthma is controlled or not, assess
adherence to therapy, or if they need more inhaled/oral meds
 Collaborative Care
 Goal – achieve and maintain control of disease
 Diagnose, assess severity, start treatment, and monitor periodically to
control disease - look at this table and table 28-5


Stepped up or
down depending
on control




 Intermittent and persistent asthma
 Management
 Identify and avoid/eliminate triggers
 Teach
 Drug therapy (look at chart above, 28-6, & med chart we did in
class)
 Short term meds (rescue/reliever) for all classifications
o SABAs - inhaled (albuterol)
o Anticholinergics – inhaled (ipratropium
[Atrovent HFA])
o Antiinflammatory drugs
 Corticosteroids (prednisone)
 Long term/controller meds
o Antiinflammatory drugs