Asthma is an obstructive disease that affects millions of people around the world. It is characterized by wheezing, coughing, and difficulty breathing.
In this article, we will provide an overview of asthma, its symptoms, and the treatment methods that are used in respiratory care.
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What is Asthma?
Asthma is a chronic, obstructive, respiratory condition that causes inflammation and narrowing of the airways in the lungs. This leads to recurring episodes of dyspnea and wheezing.
It varies with different levels of severity, and an episode can occur due to certain triggers and other causes.
The causes of asthma involve a combination of genetic and environmental factors. Some examples of the most common asthma triggers include:
- Animal fur
- Cold air
- Cigarette smoke
- Respiratory infections
Each patient is different; therefore, each patient may experience an asthma episode due to different triggers.
Signs and Symptoms
Asthma can cause several signs and symptoms, including the following:
- Shortness of breath
- Pursed-lip breathing
- Chest tightness
- Increased A-P diameter of the chest
- Increased accessory muscle usage while breathing
- Hyperresonant chest percussion note
- Diminished breath sounds (during a severe episode)
The patient’s vital signs may show signs of tachycardia, tachypnea, and pulsus paradoxes. Again, each patient may experience different signs and symptoms depending on the severity of their condition.
There are several methods and diagnostic tests that are useful in the diagnosis of asthma. Some examples include:
- Medical history
- Physical examination
- Laboratory tests
- Arterial blood gas
- Chest radiograph
- Pulmonary function testing
- Pre/post-bronchodilator study
The patient’s ABG results will likely initially show signs of acute alveolar hyperinflation with hypoxemia. If their condition worsens, hypercarbia and respiratory failure can occur.
The chest x-ray of a patient with asthma would show an increased A-P diameter, dark (translucent) lung fields, and flattened diaphragms.
The patient’s PFT results would show decreased flow rates. If there is a significant improvement in the patient’s FEV1 of more that 12% after receiving a bronchodilator, this is an indication that asthma is present.
The goals of treatment for asthma are to relieve symptoms, prevent exacerbations, and improve the patient’s quality of life. The most common treatment methods include:
- Oxygen therapy
- Leukotriene modifiers
As a respiratory therapist, it’s important to monitor patients close during an acute episode. Adjunct therapies may be necessary in some cases, such as heliox, magnesium sulfate, or subcutaneous epinephrine
In severe cases, intubation and mechanical ventilation may be indicated for the treatment of respiratory failure.
The long-term management of asthma symptoms is important in order to prevent acute exacerbations and improve the patient’s quality of life.
This involves eliminating or minimizing the triggers that can cause an acute episode.
The patient may also require the use of controller medications such as long-acting beta-agonists, inhaled corticosteroids, mast cell stabilizers, and leukotriene inhibitors.
Asthma Practice Questions:
1. What is the definition of Asthma?
A respiratory disorder characterized by recurring episodes of paroxysmal dyspnea, wheezing on expiration or inspiration caused by constriction of the bronchi, coughing, and viscous mucoid bronchial secretions. The episodes may be precipitated by inhalation of allergens or pollutants, infection, cold air, vigorous exercise, or emotional stress. It’s essentially hyperreactivity of the airways.
2. What does hyperractivity of the airways lead to?
Bronchoconstriction & bronchospasm, mucosal swelling, and increased production of thick tenacious mucus.
3. What are the two types of asthma?
Extrinsic and Intrinsic.
4. What kind of asthma is extrinsic?
It is considered type-one or allergenic asthma.
5. What kind of asthma is intrinsic?
It is considered type-two or non-allergenic asthma.
6. What can cause the onset of extrinsic asthma?
Pollen, mold, dander, or different foods.
7. What can cause the onset intrinsic asthma?
Stress, cold or dry air, smoke, anxiety, viruses, or infections.
8. What are signs, symptoms, and observations of asthma?
Increased respiratory rate, work of breathing, heart rate, cardiac output, and blood pressure. The patient may also have a prolonged (forceful) expiration and a decreased peak expiratory flow rate.
9. What are the breath sounds of a patient with asthma?
Wheezing – you will always hear
10. What does it mean when you do not hear wheezes when listening to an asthma patient who is clearly in distress?
This means that there is no air movement and is amongst the most serious cases of asthma. This could be life-threatening and may require intubation and mechanical ventilation.
11. What are the ABG results associated with asthma?
During a mild asthma attack, the pH may be increased with a decreased PaCO2 due to hyperventilation. During a moderate asthma attack, the pH may appear within the normal along with hypoxemia. During a severe asthma attack, the pH is decreased, the PaO2 is severely decreased, and the PaCO2 is increased, resulting from respiratory failure.
Bronchoconstriction, bronchospasm, pulmonary vasodilation, airway inflammation, and increased mucus production.
13. If the PaCO2 rises drastically and suddenly during an asthma attack, what does that mean?
It likely means that the patient isn’t moving any air and
14. What will a chest X-ray show with a patient with asthma?
You may see no significant changes. It may be slightly darkened. Also, you may see an increased capacity due to air trapping.
15. What happens to the systolic blood pressure during an asthma attack?
It will decrease during inspiration by 10-20 mmHg.
16. Which WBC increases during an asthma attack?
17. What will a PFT test show on an asthmatic?
Decreased airflow, low peak flows, and an increased residual volume. The FVC may be decreased due to air trapping, and the FEV1/FVC ratio is decreased.
18. What is the first treatment when it comes to asthma?
Prevention; avoid triggers if possible.
19. What are some medical treatments for patients that have asthma?
The patient will undergo a preventative asthma action plan and also immunotherapy.
20. What is Pulsus Paradoxus?
It is an abnormally large decrease in the patient’s stroke volume, systolic blood pressure and pulse wave amplitude during inspiration.
21. What is the 1st line of defense in asthma?
Maintenance with long-acting beta-2 agonists and inhaled corticosteroids.
22. What is the 2nd line of defense in asthma?
Fast-acting medication (Beta-2 agonists) such
23. What is the 3rd line of defense in asthma?
Emergency oral and intravenous steroids.
24. What is the 4th line of defense in asthma?
Xanthines such as aminophylline, magnesium sulfate via an IV, as well as Heliox.
25. What are some special medications used for asthma?
26. What are some prophylactic medications used for asthma?
27. When would you use Xolair (omalizumab) to treat asthma?
It can be used to treat
28. What are other treatment considerations for asthma patient?
In the emergency department, back-to-back continuous short-acting bronchodilators may be given to the patient to help alleviate bronchospasm. This is often termed as a continuous breathing treatment. Also, if you’re looking for a home remedy, tumeric has been shown to naturally reduce the symptoms of asthma.
29. True or False: A methacholine challenge test can be used in the diagnoses of asthma.
True. A methacholine challenge test is performed to determine how reactive or responsive your lungs are to different asthma triggers in the environment. The test can help your doctor evaluate symptoms suggestive of asthma and help diagnose whether or not the patient has it.
30. What are some symptoms of asthma?
31. What are some triggers of asthma?
Allergens, irritants, weather changes, viral or sinus infection, exercise, herd, medications/food, emotional anxiety.
32. What are some allergens of asthma?
Pollens, molds, animal dander, house dust mites, and cockroach droppings.
33. What is an allergen?
They affect only people allergic to a specific substance.
34. What is an irritant?
The effect everyone if the dose is high enough.
35. What are some examples of irritants?
Tobacco smoke, wood smoke, chemicals in the air, ozone, perfumes, household cleaners, cooking fumes, paints, and varnishes.
36. What are some occupational irritants?
Vapors, dust, gases, and fumes.
37. What are some other common causes of asthma?
Viral and sinus infections, exercise, reflux disease herd, medications (NSAIDS), beta blockers, and emotional anxiety.
38. What are the types of medications that help with asthma symptoms?
Antihistamines, decongestants, anti-inflammatory agents, anti-leukotrienes, bronchodilators, and anticholinergics.
39. What are the 3 types of medications that are used as anti-inflammatory agents?
Mast cell stabilizers, corticosteroids, and bronchodilators.
40. What are the classes of bronchodilators available for asthma?
Beta-agonist bronchodilators, methylxanthines, and anticholinergics.
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41. What are methylxanthines?
PDE inhibitors such as theophylline, aminophylline, and theobromide.
42. What are rescue medications?
They are there for when a patient has symptoms of an asthma attack.
43. What are maintenance medications?
They are there for when a patient doesn’t have symptoms and but are meant to help control the disease.
44. How do anticholinergics work?
They block the veal nerve in bronchoconstriction and can be used alone or along with bronchodilators. Some examples include Atrovent and Spiriva (tiotropium bromide). These are better for COPD rather than asthma.
45. What are the 6 goals for the effective management of asthma?
(1) To prevent chronic and troublesome symptoms, (2) to maintain normal breathing, (3) to maintain normal activity levels including exercise, (4) to prevent recurrent asthma flare-ups, (5) to minimize the need for emergency room, and (6) to provide optimal medication therapy with no or minimal effort.
46. What are the 4 categories of asthma?
(1) Mild intermittent, (2) mild persistent, (3) moderate persistent, and (4) severe persistent.
47. What are the rules of 2 for asthma medications that tell you that your asthma is not under control?
You use a rescue inhaler more than 2 times a week, you awaken at night with asthma symptoms more than 2 times a month, you use more than 2 canisters a year of rescue medications (inhaler).
48. What are quick-relief medications?
Short-acting beta-2 agonists, inhaled anticholinergics, short-acting theophylline, epinephrine/ adrenaline injection.
49. What are examples of long-term asthma medications?
Corticosteroids, tablets or syrup steroids, mast cell stabilizers, long-acting beta-2 agonist, sustained-release tablets, sustained release methylxanthines, anti-leukotrienes.
50. What is immunotherapy?
It’s a form of antigen extract to desensitize the patient to asthma triggers. It can help to reduce asthma symptoms, as well as the need for medications. It can also help reduce the risk of severe asthma attacks after future exposure to the allergen. It has been shown to possibly be as effective as inhaled steroids.
Asthma is a chronic inflammatory disease of the airways characterized by hyperresponsiveness and inflammation. The specific causes include combination of genetic and environmental factors.
Respiratory therapists are involves in the diagnosis, treatment, and management of asthmatic patients. Their role is especially important during an acute exacerbation.
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
- Clinical Manifestations and Assessment of Respiratory Disease. Mosby; 8th Edition, 2019.
- “Diagnosis and Management of Asthma – Statement on the 2015 GINA Guidelines.” PubMed Central (PMC), 31 Aug. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC5010591.
- “Asthma Exacerbations: Pathogenesis, Prevention, and Treatment.” PubMed Central (PMC), 6 July 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5950727.
- World Health Organization: WHO. “Asthma.” World Health Organization, 20 May 2020, www.who.int/news-room/fact-sheets/detail/asthma.