Asthma ManagementPathophysiology and Management

University of UtahCenter for Emergency Programs

and

The Utah Asthma Program

Asthma Pathophysiology

Asthma Description

Asthma is defined as a chronic inflammatory disorder of the airways. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or early in the morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment.

Asthma Triggers

• Indoor Air Pollutants• Outdoor Air Pollutants• Other Types of Triggers

Indoor Air Pollutants

• Second Hand Smoke• Combustion Products• Biologicals• Volatile Organic

Compounds

Outdoor Air Pollutants

• Ozone (O3)• Particulate Matter

– Nitrogen Dioxide (NO2)– Sulfur Dioxide (SO2)

Other Types of Triggers

• Vigorous Exercise• Exposure to Cold

– Sudden Changes in Temperature• Excitement• OTC Medications

– Non-SteroidalAnti-Inflammatories

Specific Pathophysiology

• With exposure to a trigger, a cascade of cellular responses result in:– Increased mucus production– Mucosal swelling– Bronchial muscle contraction

Pathophysiology Continued

• Early Acute Result is:– Hyperesponsiveness– Obstruction

• Late Acute Result is:– Recurrence of symptoms in 4-12 hours

• Chronic Result is:– Airway Remodeling

Asthma Signs and Symptoms

Classification of Asthma

• Mild Intermittent Asthma• Mild Persistent Asthma• Moderate Persistent Asthma• Severe Persistent Asthma

Asthma as a Diagnosis

Special Populations

• Infants• Children• Teenagers• Pregnant Women

Asthma Management

Asthma Management Plan

• Medications• Management Goals• Physician Information• Individual Triggers

Asthma Action Plan

• Peak Flow Measurements• Asthma Symptoms• Asthma Medications• Emergency Numbers

Asthma Medications• Bronchodilators (Sympathomimetics) • Bronchodilators (Anticholinergics) • Inhaled Corticosteroids• Biologic Response Modifiers

(Monoclonal Antibodies)• Leukotriene Receptor Antagonists• Mast Cell Stabilizers• Methylxanthene Derivatives

Bronchodilators (Sympathomimetics)

• Albuterol• Salmeterol• Terbutaline

Bronchodilators(Anticholinergics)

• Ipratropium

Inhaled Corticosteroids

• Beclamethasone• Flunisolide• Triamcinalone

Biologic Response Modifiers (Monoclonal Antibodies)

• Omalizumab

Leukotriene Receptor Antagonists

• Montelukast• Zafirlukast

Mast Cell Stabilizers

• Cromolyn• Nedocromil

Methylxanthene Derivatives

• Theophylline

Additional & Alternative Therapies

• Asthma Education

• Cognitive Behavioral Therapy– Relaxation Exercises

• Chinese Herbal Therapyhttp://nccam.nih.gov/

Implications for EMS Providers

• Recognize Asthma Triggers• Recognize Asthma Symptoms• Understand …