p.31
Diagnosis and Assessment of Asthma
What is the purpose of the Asthma Control Test?
To assess symptom control in asthma patients.
What characterizes asthma with persistent airflow limitation?
It occurs in long-standing asthma and is incompletely reversible due to airway wall remodeling.
p.47
Diagnosis and Assessment of Asthma
What is one reason for short-term monitoring of peak flow?
To monitor recovery following an exacerbation.
What is a key feature of adult-onset (late-onset) asthma?
It is usually non-allergic and requires high doses of inhaled corticosteroids (ICS).
p.4
Definition and Pathophysiology of Asthma
What can chronic asthma lead to in terms of airway structure?
Airway remodeling due to bronchial wall inflammation.
p.28
Diagnosis and Assessment of Asthma
What do arterial blood gas studies typically show in asthma patients?
Decreased PaO2 and increased PaCO2.
p.47
Diagnosis and Assessment of Asthma
When should peak flow monitoring be conducted after a change in treatment?
To help assess whether the patient has responded.
p.48
Diagnosis and Assessment of Asthma
What is the purpose of long-term monitoring of peak flow?
For earlier detection of exacerbations, especially in patients with poor perception of airflow limitation.
p.48
Diagnosis and Assessment of Asthma
Who benefits from long-term peak flow monitoring?
Patients with a history of sudden severe exacerbations.
p.26
Diagnosis and Assessment of Asthma
What is the purpose of allergy tests in asthma diagnosis?
To assess the likelihood of allergic asthma, though they are not specific to asthma.
p.3
Precipitating Factors and Clinical Manifestations
How do symptoms and airflow limitation in asthma vary?
They vary over time and in intensity.
p.1
Nursing Responsibilities and Patient Education
What will students identify related to nursing in asthma care?
The related nursing diagnoses and responsibilities for caring for clients with asthma.
p.17
Diagnosis and Assessment of Asthma
What are typical respiratory symptoms indicative of?
Possible asthma diagnosis.
p.9
Risk Factors for Asthma
What are causal factors that can trigger asthma?
Exposure to indoor and outdoor allergens and occupation sensitizers.
p.9
Risk Factors for Asthma
What are some contributing factors to asthma?
Respiratory infections, air pollution, active/passive smoking, and other factors like diet and small size at birth.
p.32
Diagnosis and Assessment of Asthma
Who are the two parties involved in the Childhood Asthma Control Test?
The child and the parents.
p.13
Clinical Manifestations and Treatment Plans
What are common symptoms of an early or mild asthma episode?
Dry cough, often occurring at night or early in the morning, and mild chest tightness.
p.60
Nursing Responsibilities and Patient Education
What should you emphasize to the client regarding their emotional state?
The importance of remaining as calm as possible.
p.44
Nursing Responsibilities and Patient Education
Who should be involved in creating a written asthma self-management action plan?
Patients, healthcare providers, and caregivers.
p.4
Definition and Pathophysiology of Asthma
Do the features of asthma persist even when symptoms are absent?
Yes, they usually persist even when symptoms are absent or lung function is normal.
p.44
Clinical Management and Treatment Plans
What key components should be included in an asthma self-management action plan?
Daily management strategies, medication usage, and emergency response actions.
p.18
Definition and Pathophysiology of Asthma
What does GINA stand for?
Global Initiative for Asthma.
p.61
Nursing Responsibilities and Patient Education
Which nursing diagnosis indicates problems with breathing?
Ineffective breathing pattern.
p.6
Global and Local Prevalence of Asthma
What challenges contribute to asthma-related deaths in low-income countries?
Under-diagnosis and under-treatment.
p.49
Clinical Management and Treatment Plans
What can severe asthma attacks lead to?
They may be life-threatening and require urgent admission to the hospital.
p.45
Clinical Management and Treatment Plans
What should be considered when choosing an inhaler device before prescribing?
Medication options, available devices, patient skills, and cost.
p.12
Definition and Pathophysiology of Asthma
What does pathophysiology study?
The functional changes that occur in the body as a result of a disease or medical condition.
p.27
Diagnosis and Assessment of Asthma
In which non-asthma conditions can FeNO be elevated?
Eosinophilic bronchitis, atopy, allergic rhinitis, and eczema.
p.4
Definition and Pathophysiology of Asthma
What is asthma usually associated with?
Airway hyperresponsiveness to stimuli and chronic airway inflammation.
What are the symptoms of asthma with obesity?
Prominent respiratory symptoms with little eosinophilic inflammation.
p.11
Definition and Pathophysiology of Asthma
How does asthma affect the airways?
Asthma causes inflammation and narrowing of the airways, leading to difficulty in breathing.
p.11
Definition and Pathophysiology of Asthma
What role do inflammatory cells play in asthma?
Inflammatory cells contribute to airway hyperresponsiveness and mucus production.
p.2
Definition and Pathophysiology of Asthma
What does variable expiratory airflow limitation mean in the context of asthma?
It refers to airflow limitation that varies over time and may become persistent later in the disease course.
p.26
Diagnosis and Assessment of Asthma
Are allergy tests specific to asthma?
No, they are not specific to asthma.
p.35
Risk Factors for Asthma
What are some medication factors contributing to poor asthma adherence?
Difficulties using inhaler devices, burdensome regimens, and multiple different inhalers.
p.49
Diagnosis and Assessment of Asthma
What terms are often used interchangeably with asthma exacerbations?
Episodes, attacks, acute severe asthma, and flare-ups.
p.14
Clinical Manifestations
What is a key symptom of cough variant asthma?
Cough may be the only symptom of asthma.
p.32
Diagnosis and Assessment of Asthma
What is the purpose of the Childhood Asthma Control Test?
To assess symptom control in children with asthma.
p.60
Clinical Management and Treatment Plans
What should you do to help a client relieve anxiety?
Stay with the client and encourage slow, deep breathing.
p.38
Pharmacological Management of Asthma
What is the purpose of controller medication in asthma management?
To reduce airway inflammation, control symptoms, and reduce future risks such as exacerbations and decline in lung function.
p.62
Diagnosis and Assessment of Asthma
Why is it important to assess arterial blood gas results and pulse oximetry readings?
They provide information about gas exchange and the adequacy of alveolar ventilation.
p.60
Nursing Responsibilities and Patient Education
What should you encourage the client to do regarding their feelings?
Encourage the expression of feelings.
p.22
Diagnosis and Assessment of Asthma
What indicates a more confident diagnosis of asthma?
Excessive variability in expiratory lung function.
p.60
Non-Pharmacological Management Strategies
What relaxation technique can be taught to relieve anxiety?
Progressive muscle relaxation.
p.30
Diagnosis and Assessment of Asthma
What does the Asthma Control Test assess?
It assesses symptom control in asthma patients.
p.35
Risk Factors for Asthma
What are some reasons for unintentional poor adherence in asthma treatment?
Misunderstanding instructions, forgetfulness, absence of a daily routine, and cost.
p.30
Diagnosis and Assessment of Asthma
How often did asthma keep you from getting things done in the past 4 weeks?
Responses range from 'All of the time' to 'None of the time'.
p.35
Risk Factors for Asthma
What are some intentional factors that lead to poor adherence to asthma treatment?
Perception that treatment is unnecessary, denial or anger about asthma, inappropriate expectations, concerns about side effects, dissatisfaction with healthcare providers, stigmatization, cultural or religious issues, and cost.
p.55
Clinical Management and Treatment Plans
What should be done if there is continuing deterioration in an asthma patient?
Treat as severe and reassess for ICU.
p.29
Diagnosis and Assessment of Asthma
How many questions are included in the Asthma Control Test?
5 questions (4 symptom + 1 self-assessed control).
p.7
Global and Local Prevalence of Asthma
Which organizations provided data on asthma prevalence in Hong Kong?
Census and Statistics Department, Hospital Authority, and Department of Health.
p.1
Definition and Pathophysiology of Asthma
What will students be able to state regarding asthma?
The definition and pathophysiology of asthma.
p.4
Definition and Pathophysiology of Asthma
Is the narrowing of the airway in asthma reversible?
Usually, but in some clients with chronic asthma, it may lead to irreversible obstruction.
p.2
Definition and Pathophysiology of Asthma
What are the common respiratory symptoms associated with asthma?
Wheeze, shortness of breath, chest tightness, and cough.
p.1
Clinical Management and Treatment Plans
What will students discuss regarding asthma management?
The investigation and clinical management plan for asthma.
p.18
Clinical Management and Treatment Plans
What is the purpose of the GINA guidelines?
To provide a comprehensive approach to asthma management.
p.28
Diagnosis and Assessment of Asthma
What does a chest X-ray usually reveal in an acute asthma attack?
Usually clear; hyperinflation secondary to air trapping.
p.55
Clinical Management and Treatment Plans
What symptoms indicate the need for ICU consultation in asthma management?
Drowsiness, confusion, silent chest.
p.6
Global and Local Prevalence of Asthma
In which types of countries do most asthma-related deaths occur?
Low- and lower-middle income countries.
p.62
Nursing Responsibilities and Patient Education
What should be assessed regarding cough effort?
Cough effort and sputum for color, consistency, and amount.
p.14
Pharmacological Management of Asthma
How does allergic asthma respond to ICS treatment?
It responds well to ICS treatment.
p.41
Pharmacological Management of Asthma
When should a clinician consider stepping down asthma medication?
When asthma symptoms have been well controlled and lung function has been stable for 3 or more months.
p.6
Global and Local Prevalence of Asthma
What impact does asthma have on families and communities?
Missed school and work, leading to financial impact.
p.43
Non-Pharmacological Management Strategies
How can emotional stress impact asthma management?
Dealing with emotional stress is important for asthma management.
p.17
Diagnosis and Assessment of Asthma
What is a bronchial provocation test used for?
To assess lung function variability.
p.27
Diagnosis and Assessment of Asthma
What is the FeNO level in T2-Low Asthma?
It is not elevated in T2-Low Asthma.
p.50
Precipitating Factors and Clinical Manifestations
What are common triggers for asthma exacerbations?
Viral respiratory infections, allergen exposure, food allergy, outdoor air pollution, seasonal changes, and poor adherence with ICS.
p.59
Clinical Management and Treatment Plans
What should be followed when using a nebulizer?
Infection control measures.
What will students learn to differentiate in this lecture?
The different types of asthma.
p.47
Precipitating Factors and Clinical Manifestations
Why is peak flow monitoring important if symptoms appear excessive?
To assist in identifying occupational or domestic triggers for worsening asthma control.
p.44
Nursing Responsibilities and Patient Education
How can a written asthma action plan benefit patients?
It provides clear instructions for managing asthma symptoms and helps prevent exacerbations.
p.19
Diagnosis and Assessment of Asthma
What are common respiratory symptoms that may indicate asthma?
Wheeze, shortness of breath, chest tightness, and cough.
p.3
Precipitating Factors and Clinical Manifestations
What factors can trigger variations in asthma symptoms?
Exercise, allergen or irritant exposure, change in weather, or viral respiratory infections.
p.19
Diagnosis and Assessment of Asthma
How do asthma symptoms vary over time?
They occur variably over time and vary in intensity.
p.62
Diagnosis and Assessment of Asthma
What is an early indicator of impaired gas exchange?
A fall in oxygen saturation levels.
p.28
Diagnosis and Assessment of Asthma
What is the appearance of sputum in pure asthma?
Clear, white, foamy, later becoming thicker and tenacious.
p.38
Pharmacological Management of Asthma
What is a benefit of using AIR compared to SABA relievers?
It reduces the risk of exacerbations.
p.13
Clinical Manifestations and Treatment Plans
How might a patient feel during an acute asthma episode?
Restless, apprehensive, and very anxious.
p.52
Clinical Management and Treatment Plans
What factors should be considered when assessing a patient for asthma-related death?
Severity of exacerbation and worst features.
p.45
Nursing Responsibilities and Patient Education
How can patient involvement be encouraged in choosing an inhaler device?
By allowing them to participate in the choice if different options are available.
p.45
Pharmacological Management of Asthma
What is the benefit of using a spacer with pMDIs?
It improves delivery and reduces potential side effects when using inhaled corticosteroids (ICS).
p.36
Clinical Management and Treatment Plans
What are the long-term goals of asthma management?
Control of symptoms and risk reduction.
p.20
Diagnosis and Assessment of Asthma
What is the most frequent abnormality found during auscultation in asthma patients?
Expiratory wheezing (rhonchi).
p.59
Clinical Management and Treatment Plans
When might an artificial airway be indicated?
If indicated for the patient's condition.
p.36
Clinical Management and Treatment Plans
What lung function goal should be maintained in asthma management?
Maintain normal lung function.
p.44
Nursing Responsibilities and Patient Education
What is the purpose of a written asthma self-management action plan?
To help patients manage their asthma effectively by outlining steps to take during different situations.
p.1
Precipitating Factors and Clinical Manifestations
What factors related to asthma will be described?
The precipitating factors and clinical manifestations of asthma.
p.60
Nursing Responsibilities and Patient Education
Why is it important to explain procedures to the client?
To help them understand what to expect and reduce anxiety.
p.26
Diagnosis and Assessment of Asthma
What does a positive skin test indicate?
It does NOT mean that the allergen is causing symptoms.
p.64
Nursing Responsibilities and Patient Education
What nursing action may be necessary if a client cannot clear secretions by coughing?
Provide suctioning as needed.
p.61
Nursing Responsibilities and Patient Education
Which nursing diagnosis reflects a patient's limited physical capability?
Decreased activity tolerance.
p.27
Diagnosis and Assessment of Asthma
What does exhaled nitric oxide (FeNO) indicate in asthma diagnosis?
It is higher in asthma characterized by Type 2 (T2) airway inflammation.
p.19
Diagnosis and Assessment of Asthma
What triggers asthma symptoms?
Exercise, laughter, allergens, and cold air.
p.27
Diagnosis and Assessment of Asthma
Is exhaled nitric oxide (FeNO) specific to asthma?
No, it is not specific to asthma.
p.41
Pharmacological Management of Asthma
What is the goal of stepping down asthma medication?
To find the patient’s lowest treatment that controls both symptoms and exacerbations.
p.3
Precipitating Factors and Clinical Manifestations
What is the potential impact of asthma exacerbations on patients?
They may be life-threatening and carry a significant burden.
p.40
Clinical Management and Treatment Plans
What should be checked before considering a regimen with SABA reliever?
If the patient is likely to adhere to daily controller treatment.
p.43
Non-Pharmacological Management Strategies
What should individuals with asthma avoid regarding outdoor conditions?
Outdoor air pollutants and adverse weather conditions.
p.52
Clinical Management and Treatment Plans
What indicates a severe asthma exacerbation?
Talks in words, sits hunched forward, agitated, respiratory rate >30/min, accessory muscles in use, pulse rate >120 bpm, O2 saturation <90%, PEF ≤50% predicted.
p.14
Diagnosis and Assessment of Asthma
What may be absent in cough variant asthma apart from during bronchial provocation testing?
Evidence of variable airflow limitation.
p.12
Definition and Pathophysiology of Asthma
What are the common inflammatory cells involved in asthma?
Eosinophils, mast cells, and T lymphocytes.
p.20
Diagnosis and Assessment of Asthma
When might wheezing be absent in asthma patients?
During severe asthma exacerbations due to severely reduced airflow (silent chest).
p.11
Definition and Pathophysiology of Asthma
What is pathophysiology?
The study of the functional changes that occur in the body as a result of a disease or medical condition.
p.26
Diagnosis and Assessment of Asthma
What does the presence of atopy indicate in asthma patients?
It increases the probability that a patient with respiratory symptoms has allergic asthma.
p.44
Clinical Management and Treatment Plans
What should patients do if their asthma symptoms worsen according to their action plan?
Follow the specific steps outlined for worsening symptoms, which may include using rescue medication or seeking medical help.
p.11
Definition and Pathophysiology of Asthma
What happens during an asthma attack?
The airways become severely constricted, leading to wheezing, coughing, and shortness of breath.
p.49
Diagnosis and Assessment of Asthma
What characterizes an exacerbation of asthma?
Episodes characterized by a progressive increase in symptoms like shortness of breath, cough, wheezing, or chest tightness, along with a decrease in lung function.
p.64
Nursing Responsibilities and Patient Education
What is the rationale for suctioning in patients with ineffective airway clearance?
Suctioning may be necessary to remove secretions and improve ventilation.
p.17
Diagnosis and Assessment of Asthma
What indicates excessive variability in expiratory lung function?
Evidence of significant changes in lung function measurements.
p.22
Diagnosis and Assessment of Asthma
When can lung function tests be repeated if initially negative?
During symptoms or in the early morning.
p.17
Diagnosis and Assessment of Asthma
What is one example of variation in lung function after bronchodilator administration?
An increase in lung function.
p.42
Non-Pharmacological Management Strategies
What should be avoided to reduce asthma triggers?
Occupational or domestic exposure to allergens.
p.42
Non-Pharmacological Management Strategies
What type of medications should be avoided in asthma management?
Medications that may make asthma worse.
p.19
Diagnosis and Assessment of Asthma
What is the importance of detailed history and examination in diagnosing asthma?
To determine if the history/examination supports the diagnosis of asthma.
p.12
Definition and Pathophysiology of Asthma
How does asthma affect the airways?
Asthma causes inflammation and narrowing of the airways, leading to difficulty in breathing.
p.30
Diagnosis and Assessment of Asthma
How often did asthma symptoms wake you up at night in the past 4 weeks?
Responses range from '4 or more nights a week' to 'Not at all'.
p.52
Clinical Management and Treatment Plans
What are the signs of a life-threatening asthma exacerbation?
Drowsy, confused, or silent chest.
p.16
Precipitating Factors and Clinical Manifestations
What environmental factor can trigger asthma symptoms?
Seasonal/climate changes, particularly cold air.
p.50
Precipitating Factors and Clinical Manifestations
How can food allergies affect asthma?
Food allergies can trigger asthma exacerbations.
p.51
Clinical Management and Treatment Plans
What action should be taken if PEF or FEV1 is less than 60% of the best?
Continue reliever, continue controller, add prednisolone 40-50 mg/day, and contact a doctor.
p.37
Non-Pharmacological Management Strategies
What type of strategies should be included in asthma management?
Non-pharmacological strategies.
p.64
Nursing Responsibilities and Patient Education
What is a nursing intervention for ineffective airway clearance?
Increase fluid intake to 2000 – 3000 mL if not contraindicated.
p.11
Definition and Pathophysiology of Asthma
What is airway hyperresponsiveness?
An exaggerated response of the airways to various stimuli, common in asthma patients.
p.13
Clinical Manifestations and Treatment Plans
What indicates an acute onset of asthma symptoms?
Audible wheezing and shortness of breath.
p.46
Nursing Responsibilities and Patient Education
What is the first step to ensure effective use of inhaler devices?
Show the patient how to use the device correctly with a physical demonstration, using a placebo inhaler.
p.55
Clinical Management and Treatment Plans
What are the characteristics of mild or moderate asthma exacerbation?
Talks in phrases, prefers sitting, not agitated, increased respiratory rate, no accessory muscle use, pulse rate 100-200 bpm, oxygen saturation 90-95%, PEF >50% predicted.
p.61
Nursing Responsibilities and Patient Education
Which nursing diagnosis pertains to a patient's ability to manage their health?
Ineffective health self-management.
p.5
Global and Local Prevalence of Asthma
What is the prevalence of asthma in the United States?
Data from the Institute for Health Metrics and Evaluation, 2019.
p.46
Nursing Responsibilities and Patient Education
What should clinicians be able to demonstrate regarding inhalers?
Correct technique for each of the inhalers they prescribe.
p.22
Diagnosis and Assessment of Asthma
What should be done before and after administering a bronchodilator?
Perform lung function test(s), e.g., spirometry or PEF.
p.63
Nursing Responsibilities and Patient Education
What nursing intervention can assist with airway clearance?
Initiate or assist with chest physiotherapy, including percussion and postural drainage.
p.43
Non-Pharmacological Management Strategies
What dietary considerations should be made for asthma management?
Avoidance of certain foods and food chemicals.
p.30
Diagnosis and Assessment of Asthma
How is asthma control rated in the Asthma Control Test?
From 'Not controlled at all' to 'Completely controlled'.
p.24
Diagnosis and Assessment of Asthma
How is diurnal PEF variability calculated?
Using the formula: ([Day’s highest - day’s lowest]/mean of day’s highest and lowest) x 100.
p.24
Diagnosis and Assessment of Asthma
What indicates an increase in lung function after anti-inflammatory treatment for adults?
An increase in FEV1 by ≥ 12% and ≥ 200 mL (or PEF by ≥ 20%) after 4 weeks of ICS-containing treatment.
p.50
Precipitating Factors and Clinical Manifestations
What role does outdoor air pollution play in asthma?
Outdoor air pollution is a common trigger for asthma exacerbations.
p.34
Risk Factors for Asthma
What lung function characteristic is associated with Type 2 inflammation in asthma?
Higher blood eosinophils.
p.51
Clinical Management and Treatment Plans
What should be done after increasing reliever and controller medications?
Review response to treatment.
p.16
Risk Factors for Asthma
What occupational exposure can be a risk factor for asthma?
Occupation-related chemicals.
p.4
Definition and Pathophysiology of Asthma
Can the features of asthma normalize with treatment?
Yes, they may normalize with treatment.
p.48
Diagnosis and Assessment of Asthma
Which patients are recommended to monitor peak flow long-term?
Patients who have difficult-to-control or severe asthma.
p.64
Nursing Responsibilities and Patient Education
Why is increasing fluid intake important for patients with ineffective airway clearance?
It helps keep secretions thin.
p.22
Diagnosis and Assessment of Asthma
What is a key feature in diagnosing asthma?
Confirmed variable expiratory airflow limitation.
What characterizes allergic asthma?
Commences in childhood and is associated with a past and/or family history of allergic disease.
p.18
Diagnosis and Assessment of Asthma
What is Box 1-1 in the GINA 2024 guidelines?
It typically summarizes key recommendations or concepts related to asthma management.
p.46
Clinical Management and Treatment Plans
When should an alternative inhaler device be considered?
If the patient cannot use the inhaler correctly after several repeats of training.
p.62
Nursing Responsibilities and Patient Education
What may ineffective cough signal?
Impending respiratory failure.
p.55
Pharmacological Management of Asthma
What treatments are recommended for severe asthma exacerbation?
SABA, ipratropium bromide, controlled oxygen, oral or IV corticosteroids, consider IV magnesium, consider high dose ICS.
p.43
Non-Pharmacological Management Strategies
What is a recommended strategy to manage asthma related to outdoor environments?
Avoidance of outdoor allergens.
p.21
Diagnosis and Assessment of Asthma
What should be measured before and after bronchodilator administration?
Lung function tests such as spirometry or PEF.
p.37
Clinical Management and Treatment Plans
What is the first step in the asthma management cycle?
Confirmation of diagnosis if necessary.
p.41
Pharmacological Management of Asthma
What should be documented before stepping down asthma medication?
The asthma status and clear instructions for the patient.
p.41
Pharmacological Management of Asthma
What should be provided to the patient during the stepping down process?
A written asthma action plan and sufficient medication to resume the previous dose if necessary.
p.27
Diagnosis and Assessment of Asthma
What other tests are used alongside FeNO in asthma diagnosis?
Levels of eosinophils in sputum and blood.
p.37
Nursing Responsibilities and Patient Education
What role do patient preferences play in asthma management?
They guide treatment goals and strategies.
p.25
Diagnosis and Assessment of Asthma
What tests should be performed to confirm variable expiratory airflow limitation?
Lung function tests, e.g., spirometry or PEF before and after bronchodilator.
p.24
Diagnosis and Assessment of Asthma
What indicates an increase in lung function after anti-inflammatory treatment for children?
An increase in FEV1 of ≥ 12% predicted (or in PEF of 15%).
p.34
Risk Factors for Asthma
What exacerbation history is a risk factor for poor asthma outcomes?
Ever intubated or in intensive care unit for asthma, or ≥ 1 severe exacerbation in the last 12 months.
p.39
Pharmacological Management of Asthma
How does using ICS-formoterol as a reliever compare to using a SABA?
It reduces the risk of exacerbations and is a simpler regimen.
p.10
Definition and Pathophysiology of Asthma
What contributes to airway remodeling in asthma?
Thickening of airway walls due to fibrosis and increased muscle thickness.
p.2
Definition and Pathophysiology of Asthma
How does the Global Initiative for Asthma (GINA) define asthma?
Asthma is a heterogeneous disease characterized by chronic airway inflammation and a history of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and intensity.
p.62
Nursing Responsibilities and Patient Education
What should be monitored to assess ineffective airway clearance?
Skin color, temperature, and level of consciousness.
p.61
Nursing Responsibilities and Patient Education
What is a common nursing diagnosis related to airway issues?
Ineffective airway clearance.
p.2
Definition and Pathophysiology of Asthma
What is a key characteristic of asthma as defined by GINA?
Chronic airway inflammation.
p.38
Pharmacological Management of Asthma
What does Anti-Inflammatory Reliever (AIR) include?
ICS-formoterol and ICS-SABA.
p.3
Precipitating Factors and Clinical Manifestations
How long can asthma symptoms sometimes be absent?
For weeks or months at a time.
p.55
Clinical Management and Treatment Plans
What are the characteristics of severe asthma exacerbation?
Talks in words, sits hunched forward, agitated, respiratory rate >30/min, accessory muscles used, pulse rate >120 bpm, oxygen saturation <90%, PEF ≤50% predicted.
p.19
Diagnosis and Assessment of Asthma
How do viral infections affect asthma symptoms?
Symptoms often appear or worsen with viral infections.
p.29
Diagnosis and Assessment of Asthma
What is the scoring range of the Asthma Control Test?
5 to 25, with higher scores indicating better control.
p.59
Clinical Management and Treatment Plans
What types of medications should be administered to promote oxygenation?
Bronchodilators, anti-inflammatory drugs, expectorants, and cough suppressants as prescribed.
p.30
Diagnosis and Assessment of Asthma
What does frequent use of a rescue inhaler indicate?
It may indicate poorly controlled asthma.
p.17
Diagnosis and Assessment of Asthma
What does variation in lung function beyond the normal range suggest?
Possible asthma or other respiratory conditions.
p.25
Diagnosis and Assessment of Asthma
What is considered excessive variation in lung function for adults?
Variation in FEV1 of ≥12% and ≥200 mL or in PEF of ≥20% between visits.
p.41
Pharmacological Management of Asthma
What is a feasible and safe approach for stepping down ICS dose?
Stepping down by 25-40% at 3-month intervals for most patients.
p.51
Clinical Management and Treatment Plans
What should all patients do during early or mild asthma exacerbations?
Increase reliever and early increase in controller medication.
p.37
Clinical Management and Treatment Plans
What should be treated alongside asthma?
Modifiable risk factors and comorbidities.
p.10
Definition and Pathophysiology of Asthma
What cellular components are involved in cellular infiltration during asthma?
Neutrophils, lymphocytes, and eosinophils.
p.20
Diagnosis and Assessment of Asthma
What is necessary to support the diagnosis of asthma?
A detailed history and examination.
p.39
Pharmacological Management of Asthma
What is the maintenance treatment for step 3?
Low-dose maintenance ICS-formoterol.
p.55
Diagnosis and Assessment of Asthma
What is the initial assessment for worsening asthma in the emergency department?
A: airway, B: breathing, C: circulation.
p.3
Precipitating Factors and Clinical Manifestations
How may asthma symptoms and airflow limitation resolve?
Spontaneously or in response to medication.
p.57
Non-Pharmacological Management Strategies
What are some recommended positions for promoting oxygenation?
Semi-Fowler’s, High-Fowler’s, orthopneic position, and tripod position.
p.46
Nursing Responsibilities and Patient Education
How often should inhaler technique be re-checked after initial training?
Frequently, as errors often recur within 4 - 6 weeks.
p.17
Diagnosis and Assessment of Asthma
What happens to lung function after exercise in some patients?
A decrease in lung function.
p.34
Risk Factors for Asthma
What type of exposure can increase the risk of poor asthma outcomes?
Allergy exposure of sensitized individuals.
p.50
Precipitating Factors and Clinical Manifestations
Which viral infections are known to trigger asthma exacerbations?
Rhinovirus, influenza, adenovirus, pertussis, and RSV.
p.37
Clinical Management and Treatment Plans
Why is inhaler technique important in asthma management?
It ensures proper medication delivery and adherence.
p.16
Precipitating Factors and Clinical Manifestations
How does air quality affect asthma?
Air pollution and high pollen counts can trigger asthma symptoms.
p.56
Clinical Management and Treatment Plans
What are the characteristics of mild or moderate asthma exacerbation?
Talks in phrases, prefers sitting to lying, not agitated, increased respiratory rate, no accessory muscle use, pulse rate 100-200 bpm, oxygen saturation 90-95% (room air), PEF >50% predicted or best.
p.53
Precipitating Factors and Clinical Manifestations
What are the signs of mild to moderate asthma exacerbation?
Talks in phrases, prefers sitting, respiratory rate increased, pulse rate 100-120 bpm, O2 saturation 90-95%, PEF >50% predicted.
p.50
Precipitating Factors and Clinical Manifestations
What is the impact of poor adherence with ICS on asthma?
Poor adherence with ICS can lead to worsening asthma and exacerbations.
p.56
Clinical Management and Treatment Plans
What additional treatments may be considered for severe asthma exacerbation?
IV corticosteroids, IV magnesium, high dose ICS.
p.10
Definition and Pathophysiology of Asthma
What are the effects of bronchospasm in asthma?
Airway obstruction and difficulty breathing.
p.54
Clinical Management and Treatment Plans
What should be reviewed during the follow-up visit?
Symptoms and signs to determine if the exacerbation is resolving and whether prednisone should be continued.
p.13
Clinical Manifestations and Treatment Plans
What physical signs may accompany acute asthma symptoms?
Cyanosis, sweating, and tachycardia.
p.42
Non-Pharmacological Management Strategies
What is a key non-pharmacological management strategy for asthma?
Cessation of smoking and environmental tobacco smoke exposure.
p.63
Nursing Responsibilities and Patient Education
What position should a patient be placed in to facilitate breathing and lung expansion?
Fowler’s, high-Fowler’s, or orthopneic position.
p.42
Non-Pharmacological Management Strategies
How does physical activity contribute to asthma management?
It helps improve overall lung function and health.
p.21
Diagnosis and Assessment of Asthma
What tests are performed to diagnose asthma?
Lung function tests, e.g., spirometry or Peak Expiratory Flow (PEF).
p.28
Diagnosis and Assessment of Asthma
What does sputum examination reveal in asthma with infection?
Purulent greenish or yellow sputum.
p.13
Clinical Manifestations and Treatment Plans
What is a common respiratory effort observed in acute asthma episodes?
Use of accessory muscles for breathing.
p.24
Diagnosis and Assessment of Asthma
What is a key feature for diagnosing variable expiratory airflow limitation?
Excessive variability in twice-daily PEF over 2 weeks.
p.34
Risk Factors for Asthma
What is a significant risk factor for poor asthma outcomes related to substance use?
Smoking and e-cigarettes.
p.57
Non-Pharmacological Management Strategies
What technique involves exhaling forcefully to clear airways?
Forced expiratory technique.
p.37
Clinical Management and Treatment Plans
What should be controlled in asthma management?
Symptoms and modifiable risk factors.
p.63
Nursing Responsibilities and Patient Education
How do percussion and postural drainage help patients?
They facilitate the movement of secretions and airway clearance.
p.16
Risk Factors for Asthma
What is a significant factor in assessing asthma risk related to genetics?
Positive family history of asthma.
p.23
Diagnosis and Assessment of Asthma
What increase in PEF indicates a positive bronchodilator responsiveness test?
≥ 20%, if spirometry is not available.
p.40
Clinical Management and Treatment Plans
What is the treatment for daily symptoms or low lung function?
Consider high dose maintenance ICS - LABA, possibly with add-on therapies.
p.16
Diagnosis and Assessment of Asthma
Which type of blood test results may indicate asthma?
Elevated eosinophils and elevated IgE levels.
p.10
Definition and Pathophysiology of Asthma
What is a consequence of autonomic dysregulation in asthma?
Release of toxic neuropeptides.
p.56
Clinical Management and Treatment Plans
What should be done for patients with severe asthma exacerbation who are not improving?
Continue treatment and reassess frequently.
p.33
Risk Factors for Asthma
What can inadequate prescription of ICS lead to?
Increased risk of poor asthma outcomes.
p.54
Nursing Responsibilities and Patient Education
What should be assessed regarding the asthma action plan during follow-up?
Whether it is understood, used appropriately, and if it needs modification.
p.38
Pharmacological Management of Asthma
How does AIR provide symptom relief?
It provides rapid symptom relief along with a small dose of ICS.
p.13
Clinical Manifestations and Treatment Plans
What happens to the cough during an acute asthma episode?
The cough becomes productive with mucoid sputum.
p.63
Nursing Responsibilities and Patient Education
What is the rationale for placing a patient in Fowler’s position?
These positions reduce the work of breathing and increase lung expansion.
p.29
Diagnosis and Assessment of Asthma
What does the Asthma Control Test assess?
Symptom control in asthma patients.
p.57
Non-Pharmacological Management Strategies
Why is it important to encourage frequent changes in position?
To promote better oxygenation.
p.14
Pharmacological Management of Asthma
How does non-allergic asthma respond to ICS treatment?
It demonstrates a lesser short-term response to ICS.
p.25
Diagnosis and Assessment of Asthma
What is a positive bronchial challenge test for adults?
A fall from baseline in FEV1 of ≥20% with methacholine, ≥15% with hyperventilation, hypertonic saline, or mannitol challenge, or >10% and >200mL with exercise challenge.
p.22
Diagnosis and Assessment of Asthma
Why is PEF considered less reliable than spirometry?
Because it may not provide as accurate a measure of lung function.
p.23
Diagnosis and Assessment of Asthma
What is a key feature in diagnosing variable expiratory airflow limitation?
Positive bronchodilator responsiveness test with spirometry or PEF.
p.8
Global and Local Prevalence of Asthma
How many deaths does asthma account for worldwide each year?
Approximately 420,000 deaths.
p.40
Clinical Management and Treatment Plans
What is the first step for patients with symptoms twice a month or more?
Low dose maintenance ICS.
p.57
Non-Pharmacological Management Strategies
What breathing technique focuses on using the diaphragm?
Diaphragmatic breathing technique.
p.25
Diagnosis and Assessment of Asthma
What is the excessive variation in lung function for children?
Variation in FEV1 of ≥12% or ≥15% in PEF between visits.
p.20
Diagnosis and Assessment of Asthma
What should be assessed in patients with chronic or recurrent respiratory symptoms?
Whether the symptoms are typical of asthma.
p.23
Diagnosis and Assessment of Asthma
When should lung function tests be performed in relation to bronchodilator administration?
Before and after bronchodilator use.
p.56
Clinical Management and Treatment Plans
What initial treatments are recommended for severe asthma exacerbation?
SABA, consider ipratropium bromide, controlled oxygen to maintain saturation 93-95% (children 94-98%), oral corticosteroids.
p.53
Precipitating Factors and Clinical Manifestations
What are the signs of a life-threatening asthma exacerbation?
Drowsy, confused, or silent chest.
p.53
Pharmacological Management of Asthma
How should SABA be administered during an asthma exacerbation?
4-10 puffs by pMDI + spacer, repeat every 20 minutes for 1 hour.
What distinguishes non-allergic asthma from allergic asthma?
Non-allergic asthma is not associated with allergy.
p.22
Diagnosis and Assessment of Asthma
What tests can be performed to assess lung function?
Spirometry or Peak Expiratory Flow (PEF).
p.49
Diagnosis and Assessment of Asthma
What does a change in symptoms and lung function indicate in asthma patients?
It indicates a need for a change in treatment.
p.41
Pharmacological Management of Asthma
What factors should be considered when choosing the appropriate time to step down medication?
No respiratory infection, not traveling, and not pregnant.
p.42
Non-Pharmacological Management Strategies
What dietary approach can benefit asthma patients?
Maintaining a healthy diet.
What is a key component of effective asthma self-management education?
Self-monitoring of symptoms and/or lung function.
p.12
Definition and Pathophysiology of Asthma
What role do bronchial hyperresponsiveness play in asthma?
It leads to exaggerated airway constriction in response to various stimuli.
p.57
Non-Pharmacological Management Strategies
What is the purpose of pursed-lip breathing?
To help control breathing and improve oxygenation.
p.41
Pharmacological Management of Asthma
How should symptoms be monitored during the stepping down process?
By monitoring symptoms and/or Peak Expiratory Flow (PEF), and scheduling a follow-up.
p.45
Nursing Responsibilities and Patient Education
What should be done to ensure proper inhaler technique?
Check technique at every opportunity and ask the patient to demonstrate their use of the inhaler.
p.40
Clinical Management and Treatment Plans
What should be done if symptoms occur most days or waking with asthma once a week?
Increase to low dose maintenance ICS - LABA.
p.50
Precipitating Factors and Clinical Manifestations
How do seasonal changes affect asthma?
Seasonal changes can trigger asthma exacerbations.
p.10
Definition and Pathophysiology of Asthma
Which interleukins are involved in immune activation in asthma?
IL-4, IL-5, IL-8, IL-13, IL-17, and IgE production.
p.37
Nursing Responsibilities and Patient Education
What is a key aspect of patient satisfaction in asthma management?
Addressing comorbidities and treatment preferences.
p.54
Clinical Management and Treatment Plans
What is the first step in managing worsening asthma?
Continue treatment with SABA as needed.
What is a specific allergic condition that can affect asthma patients?
Allergic bronchopulmonary aspergillosis.
p.39
Pharmacological Management of Asthma
What should be added in step 5 if symptoms persist?
Add-on LAMA and consider high-dose maintenance ICS-formoterol.
p.33
Risk Factors for Asthma
How does poor adherence affect asthma management?
It is a risk factor for poor asthma outcomes.
p.54
Clinical Management and Treatment Plans
What adjustments may be made to the reliever and controller medications during follow-up?
Reduce reliever to as-needed and continue higher dose of controller for short or long term, depending on the exacerbation background.
p.33
Risk Factors for Asthma
How does pregnancy affect asthma management?
It is considered a risk factor for poor asthma outcomes.
p.52
Clinical Management and Treatment Plans
What are the characteristics of a mild to moderate asthma exacerbation?
Talks in phrases, prefers sitting, not agitated, increased respiratory rate, no accessory muscle use, pulse rate 100-120 bpm, O2 saturation 90-95%, PEF >50% predicted.
p.21
Diagnosis and Assessment of Asthma
What does spirometry help confirm in asthma diagnosis?
Variable expiratory airflow limitation.
p.8
Global and Local Prevalence of Asthma
Where is the current asthma prevalence highest?
In areas with the lowest annual household income.
p.45
Diagnosis and Assessment of Asthma
What physical barriers should be checked to ensure effective inhaler use?
Conditions like arthritis that may limit the use of the inhaler.
What should be included in a written asthma action plan?
Instructions for managing worsening asthma and exacerbations.
p.12
Definition and Pathophysiology of Asthma
What is the result of airway remodeling in chronic asthma?
Permanent changes in the airway structure, leading to persistent symptoms.
p.10
Definition and Pathophysiology of Asthma
What are vasoactive mediators involved in?
They play a role in vasodilation and increased capillary permeability.
p.53
Clinical Management and Treatment Plans
What is the initial treatment for worsening asthma?
SABA (Short-Acting Beta Agonist) as needed.
p.10
Definition and Pathophysiology of Asthma
What triggers immune activation in asthma?
Allergen or irritant exposure.
p.40
Clinical Management and Treatment Plans
What should be checked before considering any step up in treatment?
Common problems like inhaler technique, adherence, allergen exposure, and comorbidities.
p.53
Precipitating Factors and Clinical Manifestations
What characterizes a severe asthma exacerbation?
Talks in words, sits hunched forward, respiratory rate >30/min, pulse rate >120 bpm, O2 saturation <90%, PEF ≤50% predicted.
What gastrointestinal condition is associated with asthma?
Gastroesophageal reflux disease.
p.39
Pharmacological Management of Asthma
What is the recommended reliever dosage for steps 1-2?
As-needed low-dose ICS-formoterol.
p.53
Clinical Management and Treatment Plans
What is the target oxygen saturation for controlled oxygen therapy?
93-95% for adults, 94-98% for children.
p.10
Definition and Pathophysiology of Asthma
What is impaired mucociliary function associated with?
Increased mucus secretion and airway obstruction.
p.17
Diagnosis and Assessment of Asthma
How can lung function variation be monitored over time?
Through separate visits or home monitoring over at least 1-2 weeks.
p.34
Risk Factors for Asthma
How does air quality affect asthma outcomes?
Air pollution exposures are a risk factor for poor asthma outcomes.
p.45
Diagnosis and Assessment of Asthma
How can errors in inhaler use be identified?
By using a device-specific checklist.
p.59
Non-Pharmacological Management Strategies
What techniques can be performed to aid in lung clearance?
Percussion, vibration, and postural drainage.
p.37
Nursing Responsibilities and Patient Education
What is essential for effective asthma education?
Skills training for patients and caregivers.
p.39
Pharmacological Management of Asthma
What should be assessed before considering a step up in treatment?
Inhaler technique, adherence, persistent allergen exposure, and comorbidities.
p.33
Risk Factors for Asthma
What is the impact of incorrect inhaler technique on asthma?
It can lead to poor asthma outcomes.
p.25
Diagnosis and Assessment of Asthma
What indicates a positive bronchial challenge test for children?
A fall from baseline in FEV1 of >12% predicted or a fall in PEF >15% with standardized exercise challenge.
p.45
Clinical Management and Treatment Plans
Why should the use of multiple different inhaler types be avoided?
To prevent confusion for the patient.
p.50
Precipitating Factors and Clinical Manifestations
What types of allergens can trigger asthma exacerbations?
Grass pollen, soybean dust, and fungal spores.
p.20
Diagnosis and Assessment of Asthma
What other signs are usually present when wheezing is absent during severe asthma exacerbations?
Other physical signs of respiratory failure.
p.34
Risk Factors for Asthma
What lung function measurement indicates a risk for poor asthma outcomes?
Low FEV1, especially <60% predicted.
p.53
Clinical Management and Treatment Plans
What should be done while waiting for transfer to an acute care facility?
Give SABA, ipratropium bromide, O2, and systemic corticosteroid.
p.56
Clinical Management and Treatment Plans
What indicates a need for discharge planning in moderate asthma exacerbation?
FEV1 or PEF <60% of predicted or personal best, or lack of clinical response.
p.33
Risk Factors for Asthma
What is a risk factor for poor asthma outcomes related to SBAB use?
High SBAB use (≥ 3 x 200-dose canisters/year) is associated with increased risk of exacerbations and mortality.
p.34
Risk Factors for Asthma
What socioeconomic factor can impact asthma management?
Major psychological or socioeconomic problems.
p.23
Diagnosis and Assessment of Asthma
What is the required increase in FEV1 for children to confirm bronchodilator responsiveness?
≥ 12% predicted (or in PEF of ≥15%).
p.29
Diagnosis and Assessment of Asthma
Why is it important to clarify symptoms in the Asthma Control Test?
To ensure symptoms are due to asthma.
p.56
Clinical Management and Treatment Plans
What are the signs of severe asthma exacerbation?
Talks in words, sits hunched forward, agitated, respiratory rate >30/min, accessory muscles being used, pulse rate >120 bpm, oxygen saturation <90% (room air), PEF ≤50% predicted or best.
p.24
Diagnosis and Assessment of Asthma
What lung function tests should be performed to confirm variable expiratory airflow limitation?
Spirometry or PEF before and after bronchodilator.
p.37
Diagnosis and Assessment of Asthma
What should be monitored in asthma management?
Symptoms, exacerbations, side effects, and lung function.
p.10
Definition and Pathophysiology of Asthma
What is bronchial hyperresponsiveness?
Increased contractile response of bronchial smooth muscle.
p.33
Risk Factors for Asthma
What role do confirmed food allergies play in asthma?
They are a risk factor for poor asthma outcomes.
p.40
Clinical Management and Treatment Plans
What additional treatments may be needed for severely uncontrolled asthma?
Short course OCS may also be needed.
p.10
Definition and Pathophysiology of Asthma
What occurs during mast cell degranulation?
Release of inflammatory mediators that contribute to asthma symptoms.
p.23
Diagnosis and Assessment of Asthma
What is the significance of withholding long-acting bronchodilators before the test?
It increases the likelihood of a positive test result.
p.56
Diagnosis and Assessment of Asthma
What lung function measurements should be taken one hour after initial treatment?
FEV1 or PEF 60-80% of predicted or personal best and symptoms improved.
p.54
Clinical Management and Treatment Plans
What should be arranged at discharge for asthma management?
Continue reliever as needed, start or step up controller, check inhaler technique and adherence, and continue prednisolone for 5-7 days.
p.40
Pharmacological Management of Asthma
What is the role of anti-inflammatory relievers in asthma management?
Used in Steps 3 - 5 for better control.
p.36
Clinical Management and Treatment Plans
What should be minimized in asthma management?
Medication side effects, including OCS.
p.54
Clinical Management and Treatment Plans
What is the follow-up timeframe for asthma management after discharge?
Within 2-7 days (1-2 days for children).
p.54
Clinical Management and Treatment Plans
What criteria indicate a patient can be discharged after an asthma exacerbation?
Symptoms improved, not needing SABA, PEF >60-80% of personal best, oxygen saturation >94% on room air, and adequate resources at home.
p.54
Risk Factors for Asthma
What should be checked and corrected regarding risk factors during follow-up?
Modifiable risk factors that may have contributed to the exacerbation, including inhaler technique and adherence.
p.39
Pharmacological Management of Asthma
What does AIR stand for in asthma management?
Anti-inflammatory reliever.
p.33
Risk Factors for Asthma
How can side effects of medications influence asthma management?
They can contribute to poor asthma outcomes.
p.33
Risk Factors for Asthma
How does gastroesophageal reflux disease (GERD) relate to asthma?
It is a risk factor for poor asthma outcomes.
