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The Ins & Outs of Asthma

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Asthma is a chronic inflammatory disorder of the airways. 1 in 9 Australians reported having Asthma throughout 2014-15. In 2015, there were approximately 421 deaths due to Asthma in Australia.

Cause of the Condition:

Asthma is initially caused from a bronchial spasm and an increase in mucus production within the airways. This causes the smooth muscle to contract and create a narrowing effect of the airways. A narrowing effect of the airways will ultimately cause difficulty ventilating.

There are several things which can cause this response. Here is an A-J list:

A- Allergens (pollens, animal dander, dust mites & mould)

B- Bronchial infection

C- Cold air

D- Drugs (aspirin, NSAIDS & Beta blockers)

E- Emotions (stress & laughter)

F- Food (seafood, nuts & monosodium glutamate)

G- Gastro-oesophageal reflux

H- Hormones (pregnancy & menstruation)

I- Irritants (smoke, perfumes & odours)

J- Job (dust from wood & other materials)

Assessment:

A patient suffering from an asthma attack will generally be pale, short of breath, sweaty, scared and have difficulty breathing/speaking. Upon expiration, the patient will generally make a wheezing noise, however, this can also occur upon inhalation in more serious cases.

The first step of the assessment process is to check the patient’s oxygen saturation levels. Upon assessment, the patient suffering from a severe asthma attack will generally have oxygen saturation levels below 90%.

The next step of the assessment process is to listen to the patient’s breathing. With the patient breathing through their mouth, listen for a ‘whistle’ sound generally made during expiration. This ‘whistle’ noise is a sign that the patient is having difficulty breathing.

Management:

The first step of the management process is to check the ABC’s (Airway, Breathing & Circulation). Ensure that the patient can maintain their airway and can breathe normally. The final check is to ensure that there is adequate circulation. This can be done by checking for a pulse (rate, rhythm and character).

Once the patient has successfully passed the ABC tests, if they are pale, short of breath, sweaty, scared and/or they are having difficulty breathing, a pharmacotherapy approach should be initiated.

The first line treatment is Salbutamol (Blue Puffer – Ventolin or Asmol). This is a Short Acting Beta Agonist (SABA). There should be 4-6 puffs delivered (ideally through a spacer). The process:

  1. Shake
  2. Prime
  3. 1 Puff into spacer
  4. Patient takes 4 deep breaths
  5. Repeat 4 times
  6. This dose can be delivered every 4 minutes if required

If the patient is still short of breath, the second line treatment is Oxygen therapy.

The third line treatment is an ICS (Inhaled Cortico Steroid).

Impact of Management:

Management should aim to:

Develop Risk Prevention Strategies:

  • Prevention of exacerbation’s requiring emergency treatment or hospital care
  • Prevention of reduced lung growth
  • Optimisation of pharmacology with minimal adverse effects

The way in which we assess how a patient is managing their asthma is to ask about:

  • Awakening- due to shortness of breath or chest tightness
  • SABA use
  • Troubling signs or symptoms
  • History
  • Medication side effects
  • Activities- impact of asthma on daily activities

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