EXTRINSIC ASTHMA / ATOPIC Asthma can be characterized by recurrent dyspnea with airway inflammation and wheezing due to spasmodic constriction of the bronchi. An acute attack that lasts for several da ys is known as status asthmaticus. (life threatening) 250,000–345,000 people die per year from the disease More common in boys than girls

 3 CLASSIFICATIONS OF ASTHMA Allergic or atopic asthma is EXTRINSIC asthma; due to an allergy to antigens. INTRINSIC asthma; usually secondary to chronic or current infections of the bronchi, sinuses, or tonsils and adenoids (large lymphatic tissue) can be caused by hypersensitivity to bacteria / viruses. The third type of asthma is MIXED; due to combination of extrinsic and intrinsic factors. Attacks can be stimulated by infections, emotional factors, and exposure to variety of irritants.

MOST COMMON IS EXTRINSIC ASTHMA Extrinsic Asthma associated with inherited genetics. Linked to hypersensitivity to the immune response. Triggered by allergic disorders, emotional stress, environmental c hanges in humidity and temperatu re, and exposure to noxious fumes or other airborne allergens.

ALLERGEN TRIGGERS Allergens suspended in the air; from pollen, dust, smoke, mold, dust mites, automobile exhaust, or animal dander. Environmental factors. Exercising / Stress can also trigger asthma attacks.

SYMPTOMS OF ASTHMA ATTACK Signs include dyspnea with wheezing in respiration’s Classic sitting position, leaning forwar d using all the accessory muscles of respiration. Skin can be pale with moist precipitation. Severe attacks can show cyanosis of lips and nail beds.

Short-acting B2 - agonists Adrenergics B2 - stimulants Sympathomimetics stimulants. Stimulates adenylyl cyclase activity; closing of calcium channel (smooth muscle relaxation) Albuterol/salbutamol Fenoterol Levalbuterol Metaproterenol Pirbuterol Terbutaline PHARMOCOLOGY MANAGEMENT LABA'S Formoterol Salmeterol When coupled with corticosteroids may prolong anti inflamation response.

(Antihistamines) block the actions of histamine which is a mediator in the inflammation response. Zyrtec Palgic Clarinex Benadryl Common uses for Alergic Rhinitis PHARMOCOLOGY MANAGEMENT (Anti-Leukotrienes ) work by blocking a chemical reaction that can lead to inflammation Montelukast Zafirlukast (Anti-IgE) Keeps inflammation from developing. Blocks immunoglobulin E, substance in the body which causes of inflammation in allergic asthma. Omalizumab (Xolair) Cromolyn sodium

Corticosteroids AKA Glucocorticoids ; Anti inflammatory / immunosuppressant medications are given in severe cases. Beclomethasone Budesonide Ciclesonide Flunisolide Fluticasone Mometasone Triamcinolon hydrocortisone methylprednisolone prednisolone prednosone PHARMACOLOGY MANAGEMENT (Combinations Drugs) mixture of Corticosteroid and LABA'S. Symbicort Advair

PFT / SPIROMETRY TESTING Most accurate in ages above 7 yrs Obstructive pattern in PFT testing. This includes a decrease in the rate of maximal expiratory air flow (a decrease in FEV1 and the FEV1/FVC ratio) due to the increased resistance, and a reduction in forced vital capacity (FVC).

PEF / PEAK FLOW TESTING If PEF drops below 80% of your personal best, follow your asthma action plan. Age & Height – appendix guide. Consider; peak flow measurements are not reliable for the younger aged. Not reliable during acute attacks. In younger population more attention should be given to asthma symptoms.

*Management goals for status asthmaticus. (1) To reverse airway obstruction rapidly through the aggressive use of beta2- agonist agents (2) Early use of corticosteroids. (3) to correct hypoxemia by monitoring and administering supplemental oxygen, (4) to prevent or treat complications such as pneumothorax and respiratory arrest. STATUS ASMATICUS Acute exacerbation of asthma that remains unresponsive to initial treatment of bronchodilators. Can vary from a mild to severe with bronchospasm, airway inflammation, mucus plugging that can cause difficulty breathing, carbon dioxide retention, hypoxemia. Can lead to respiratory failure. *Typically, patients present a few days after the onset of a viral respiratory illness, following exposure to a potent allergen or irritant, or after exercise in a cold environment. Frequently, patients have underused or have been underprescribed anti-inflammatory therapy.

PATIENT EDUCATION Providing asthma education to the patient and family is a must. Educating for maintenance, monitoring and measures for environmental control. Instruction in the appropriate use of inhalers. Compliant with therapy, and to practice stress-avoidance measures. Stress factors (ie, triggers of asthma attacks) include pet dander, house dust, and mold. Discourage patients from smoking ect...

No permanent cure for extrinsic asthma. Avoiding the discussed triggers is best way to control symptoms. Plan of care must be highly individualized to meet patient needs Encourage patient and family involvement in care planing. THOUGTS FOR TREATMENT.