Asthma & COPD PDF

NURSING MANAGEMENT: OBSTRUCTIVE PULMONARY DISEASES ASTHMA & CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Obstructive Pulmonary Diseases Obstructive pulmonary diseases, the most common chronic lung diseases, include conditions characterized by increased airflow re...

NURSING MANAGEMENT: OBSTRUCTIVE PULMONARY DISEASES ASTHMA & CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Obstructive Pulmonary Diseases Obstructive pulmonary diseases, the most common chronic lung diseases, include conditions characterized by increased airflow resistance as a result of airway obstruction or narrowing. 31A-2 ASTHMA Asthma Asthma is a chronic inflammatory disorder of the airways. The hyper-responsiveness, or “twitchiness,” of the airways is directly related to the degree of airway inflammation Triggers for asthma attacks Table 31- 1 Asthma Chronic inflammatory disorder of the airways Triggers of asthma attacks – Allergens – Exercise – Respiratory infections – Nose and sinus problems – Medications and food additives 31A-6  Asthma (Cont.) Triggers of asthma attacks (Cont.) – Cold, dry air – Stress – Hormones, menses – Gastroesophageal reflux disease (GERD) – Occupational exposure 31A-7 Pathophysiology of Asthma- The hallmarks of asthma are: – Airway inflammation – Airway hyper-responsiveness Types of asthmatic responses: – Early phase response – Late phase response Pathophysiology of asthma- late phase can be more severe than the early-phase response primary characteristic is inflammation, as opposed to bronchial smooth muscle contraction Eosinophils and neutrophils, the inflammatory cells involved in asthma, infiltrate the airways  Asthma (Cont.) 31A-10 Asthma (Cont.) Clinical manifestations Asthma control and severity – Severe acute asthma and life-threatening asthma 31A-11 Asthma (Cont.) Refer to Table 31.2, Asthma Control Criteria, in textbook 31A-12 Characteristic clinical manifestation- asthma The characteristic clinical manifestations of asthma are  wheezing  Cough  Dyspnea  sensation of chest tightness after exposure to a precipitating factor or trigger Asthma (Cont.) 31A-14 Asthma (Cont.) Diagnostic studies in asthma – Symptoms – Variable airflow obstruction Interprofessional care – General management approach – Acute asthma exacerbation 31A-15 Asthma (Cont.) Medication therapy – Relievers and controllers – Anti-inflammatory medications Corticosteroids Antileukotrienes – Biological therapy Anti-immunoglobulin E therapy 31A-16 Asthma (Cont.) Medication therapy (Cont.) – Bronchodilators β2-adrenergic agonists – Short-acting – Long-acting Anticholinergic medications Methylxanthines 31A-17 Asthma: Medication Therapy Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 31A-18 Asthma: Medication Therapy (Cont.) Refer to Table 31.6, Problems Encountered with Use of Metered-Dose Inhaler, in textbook 31A-19 Asthma: Medication Therapy (Cont.) 31A-20 Chronic Obstructive Pulmonary Disease (COPD) Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease (COPD) is a respiratory disorder caused largely by smoking and characterized by persistent airflow limitation, usually progressive, associated with an enhanced chronic inflammatory response in the airways and the lung in noxious particles or gases. Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 31A-22 Chronic Obstructive Pulmonary Disease (Cont.) Symptoms include dyspnea, difficulty breathing, or shortness of breath and limitations in activity. – Symptoms are usually insidious in onset and progressive. – Past definitions of COPD included the terms chronic bronchitis and emphysema. Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 31A-23 Chronic Obstructive Pulmonary Disease (Cont.) Causes – Tobacco smoke – Occupational chemicals and dust – Infection – Heredity – Aging Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 31A-24 Chronic Obstructive Pulmonary Disease (Cont.) Pathophysiology – Chronic inflammation found in the airways, lung parenchyma (respiratory bronchioles and alveoli), and pulmonary blood vessels – Often have characteristics of emphysema and chronic bronchitis In COPD, airflow limitation, air trapping, gas exchange abnormalities, mucus hypersecretion, and, in severe disease, pulmonary hypertension and systemic abnormalities are among the various disease processes that occur (see next slide) Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 31A-25 Chronic Obstructive Pulmonary Disease (Cont.) Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 31A-26 Chronic Obstructive Pulmonary Disease (Cont.) Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 31A-27 Chronic Obstructive Pulmonary Disease (Cont.) Refer to Table 31.12, Canadian Thoracic Society Chronic Obstructive Pulmonary Disease Classification of Severity by Symptoms, Disability, and Impairment of Lung Function, in the textbook 31A-28 Chronic Obstructive Pulmonary Disease (Cont.) Classification (Table 31.12) – Mild – Moderate – Severe – Very severe Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 31A-29 Chronic Obstructive Pulmonary Disease (Cont.) Complications – Cor pulmonale – Acute exacerbations of COPD – Acute respiratory failure – Depression and anxiety Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 31A-30 Cor Pulmonale Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 31A-31 COPD: Clinical Assessment Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 31A-32 Chronic Obstructive Pulmonary Disease (Cont.) Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. 31A-33