Theresa Till Ed.D, RN,CCRN

Pathophysiology of Asthma
 HYPERRESPONSIVENESS OF AIRWAYS that results in:
 Usually, reversible constriction of bronchial smooth muscle (bronchoconstriction).
 Hypersecretion of mucus
 Mucosal inflammation and edema
(Considered more a disease of inflammation than obstruction: obstruction occurs secondarily)

Triggers to Asthma

Asthma
(narrowed airways)

Asthma

Chronic Bronchitis


Usually caused by smoking or inhaled irritants.
“Mega” mucous
 Airway inflammation
 Irreversible

Emphysema
Alveolar Destruction

Emphysema


IRREVERSIBLE destruction of alveolar walls which decreases surface area for gas exchange.
Loss of lung elasticity: “springs” that hold open alveolar walls are “sprung” and collapse.
 Air becomes trapped and distal airways hyperinflate and rupture.

Quit smoking
 Major cause of
COPD.

Nicotine Patch

Medications that Treat
Respiratory Disease
 Steroids
–REDUCE INFLAMMATION.
–CONSIDERED A DRUG OF
PREVENTION
–Not used acutely
–Best to use spacer (aerochamber) to decrease systemic effects.
–Rinse & spit after use.
–Commonly ends in “sone,” “olone”

Bronchodilators
 Fast acting USED ACUTELY.
 Open airways. Most bronchodilators are given via nebulizer, MDI or DPI.
 Beta adrenergic agonists (erol, enol)
Common side effects are palpitations &, tachycardia. Note: If patients are using more than one canister a month
(200puffs), their disease is in poor control. Don’t use as “fire extinguisher.”
Ask why is fire breaking out?

Bronchodilators
 Bronchodilators
(fast or slow acting) work by relaxing muscle walls and thereby making the air passage larger
.

Bronchodilators
– Methylxanthines: theophylline
Aminophylline second line drug given when extra treatment is needed. Given IV or PO.
Most common side effects of aminophylline are tachycardia, shakiness, and palpitations.
– Anticholinergics: relax bronchial smooth muscle but less effective than beta agonists.
– http://www.use-inhalers.com/

Respiratory Preventatives
Mast Cell Stabilizers
 Not used acutely. Used to prevent an exacerbation of asthma.
 Examples of mast cell stabilizers:
• Cromolyn (Intal)
• Nedocromil (Tilade)
• Inhibit histamine release from mast cells thus decreasing immune response.

Respiratory Preventatives
Leukotriene Modifiers
– Not used acutely. Used to prevent an exacerbation of asthma
– Leukotriene Modifiers: interfere with synthesis or block the action of leukotrienes which cause inflammation. Examples are:
• “lukast
• Montelukast (Singulair)

Valuable Miscellaneous
Interventions

Respiratory and Physical Therapy
 Encourage to attend pulmonary rehabilitation classes (exercise supervised by professionals)
 Breathing retraining (handout)
– Purse-lip
– Diaphragmatic (abdominal breathing)
 Increase exercise tolerance
 Effective coughing
– Flutter mucus clearance device
– Acapella- hand-held device that loosens secretions via vibrations & positive pressure
 Teach patients to assess sputum
 Avoid conversation with exercise

Metered Dose Inhalers
 Common treatment.
 Note location of
MDI when a spacer or aerochamber is not used.

Peak Flow Meters

Flutter Mucus Device

COPD
 Abdominal
Breathing

Pursed Lip Breathing
 http://www.bing.com/videos/search?q=t eaching+pursed+lip+breathing+animatio n&qs=n&form=QBVR&pq=teaching+pur sed+lip+breathing+animation&sc=0-
30&sp=-
1&sk=#view=detail&mid=76EC2961EE6
5A64565A976EC2961EE65A64565A9

Nutritional Therapy
 Weight loss and malnutrition are common
• Pressure on diaphragm from a full stomach causes dyspnea
• Difficulty breathing while eating leads to inadequate consumption
• Drink fluids in between meals
• Rest at least 30 minutes prior to eating
• Frequent small meals (high calorie and protein)
• Prepare foods in advance

Respiratory Therapy
 Aerosol nebulization therapy
–Deliver suspension of fine particles of liquid (medication) in a gas
–Easy to use
–Must be kept clean at home to prevent bacterial growth

Managing Oxygen Liter Flow
 Outdated information: Never exceed 2 liters of oxygen per nasal cannula for patients with chronic lung disease because can knock out drive to breath.
This can occur but is rare.
 New standard is to use oxygen saturation level as guide to how much oxygen to deliver. Increase oxygen level to maintain therapeutic oximetry. If
Sp02 ↓ with ↑ O2, stop.
Hinkle, MD, SIU Chief of
Pulmonary Medicine