2. Asthma Triggers and Health Promotion Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved.

3. Significance  Asthma affects about 20 million Americans  Adult females have a 30% greater prevalence of asthma than males  Female death rate 42% greater than males

4. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers  Bring on symptoms of asthma  Different from person to person

5. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers (cont’d)  Asthma cannot be cured, but can be managed  Goal in asthma - minimize exposure to triggers

6. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Allergens  About 40% of cases are related to an allergic response May be seasonal or year round depending on exposure to allergen May be seasonal or year round depending on exposure to allergen Nonseasonal forms of asthma may be year round (perennial) Nonseasonal forms of asthma may be year round (perennial)  Related to allergens such as dust mites, molds, animals  Cockroaches

7. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Nursing Management Health Promotion - Allergens  Dust mites like warm places Bedding, upholstered furniture, carpeting, and stuffed toys Bedding, upholstered furniture, carpeting, and stuffed toys  Control dust and dust mites Put mattresses and pillows in special allergen-proof covers Put mattresses and pillows in special allergen-proof covers Wash bedding every week in hot water Wash bedding every week in hot water

8. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Nursing Management Health Promotion - Allergens (cont’d)  Control dust and dust mites Remove dust collectors from the bedroom Remove dust collectors from the bedroom Dust woodwork and wash curtains often Dust woodwork and wash curtains often Use a damp mop on floors instead of sweeping Use a damp mop on floors instead of sweeping

9. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Nursing Management Health Promotion - Allergens (cont’d)  Control dust and dust mites (cont’d) Vacuum carpets/rugs weekly Vacuum carpets/rugs weekly Avoid using humidifiers and use dehumidifiers in damp parts of the house Avoid using humidifiers and use dehumidifiers in damp parts of the house Replace air conditioner and furnace filters monthly Replace air conditioner and furnace filters monthly

10. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Nursing Management Health Promotion - Allergens (cont’d)  Control mold indoors Basements, kitchens, and bathrooms should be kept as clean and dry as possible. Basements, kitchens, and bathrooms should be kept as clean and dry as possible. Humidifiers and vaporizers should be avoided. Humidifiers and vaporizers should be avoided.

11. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Nursing Management Health Promotion - Allergens (cont’d)  Control mold outdoors (cont’d) Stay inside in air conditioning on damp, windy days Stay inside in air conditioning on damp, windy days

12. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Nursing Management Health Promotion - Allergens (cont’d)  Control mold Keep bathroom dry by using an exhaust fan or dehumidifier Keep bathroom dry by using an exhaust fan or dehumidifier Clean sinks, tubs, and showers with bleach solution (1 part bleach, 3 parts water) Clean sinks, tubs, and showers with bleach solution (1 part bleach, 3 parts water) Limit house plants Limit house plants Clean spacers and nebulizers often Clean spacers and nebulizers often

13. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Nursing Management Health Promotion - Allergens (cont’d)  Control pollen Weather reports tell when pollen counts are high Weather reports tell when pollen counts are high Pollen levels can be obtained on Internet by going to sites such as www. Pollen.com Pollen levels can be obtained on Internet by going to sites such as www. Pollen.com Pollen counts are lower in the evening so that is a better time to go outdoors Pollen counts are lower in the evening so that is a better time to go outdoors

14. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Nursing Management Health Promotion - Allergens (cont’d)  Control pollen (cont’d) During allergy season, use air conditioning instead of opening windows During allergy season, use air conditioning instead of opening windows Change the air conditioner filter monthly Change the air conditioner filter monthly Shower or bathe after being outdoors Shower or bathe after being outdoors

15. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Nursing Management Health Promotion - Pets  Keep pets out of bedroom and living areas  Brush and wash pets weekly  Use feather pillows  Cat litter emptied by nonallergic person

16. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Exercise  Induced or exacerbated after exercise Typically occur after vigorous exercise Typically occur after vigorous exercise Pronounced with exposure to cold air Pronounced with exposure to cold air

17. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Nursing Management Health Promotion - Exercise  Medications to promote bronchodilation 10-20 minutes before exercise 10-20 minutes before exercise Cromolyn (Intal), nedocromil (Tilade), β 2 - agonists Cromolyn (Intal), nedocromil (Tilade), β 2 - agonists  Warm up 2-3 minutes by exercising slowly at first  Limit exercise if ill or if the weather is cold and dry

18. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Air Pollutants  Can trigger asthma attacks Cigarette or wood smoke Cigarette or wood smoke Vehicle exhaust Vehicle exhaust Elevated ozone levels Elevated ozone levels Sulfur dioxide Sulfur dioxide

19. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Health Promotion - Air Pollutants  Ozone alert days Noted in newspaper Noted in newspaper Minimize outdoor activity during these times Minimize outdoor activity during these times

20. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Nursing Management Health Promotion - Smoking  Do not allow smoking in home or car  Do not use wood burning stoves or fireplaces  Avoid campfires

21. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Occupational Factors  Most common form of occupational lung disease Exposure to diverse agents Exposure to diverse agents  Arrive at work well, but experience a gradual decline during day

22. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Nursing Management Health Promotion – Occupational Factors  Nurse needs to obtain a health history Assess if symptom-free when not at work Assess if symptom-free when not at work  Use masks and proper ventilation

23. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Respiratory Infection  Major precipitating factor of an acute asthma attack ↑ inflammation hyperresponsiveness of the tracheobronchial system ↑ inflammation hyperresponsiveness of the tracheobronchial system Viruses cause asthma by activating immune system Viruses cause asthma by activating immune system

24. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Nursing Management Health Promotion - Infections  Avoid people with colds and flu  Get a yearly flu shot  Wash hands often  Eat well  Get plenty of sleep

25. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Nose and Sinus Problems  Allergic rhinitis and nasal polyps Large polyps are removed Large polyps are removed Sinus problems are usually related to inflammation of the mucous membranes Sinus problems are usually related to inflammation of the mucous membranes

26. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Drugs and Food Additives  Asthma triad: nasal polyps, asthma, and sensitivity to aspirin and NSAIDs

27. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Drugs and Food Additives (cont’d)  Symptoms related to asthma triad Wheezing develops in about 2 hrs Wheezing develops in about 2 hrs Rhinorrhea, congestion, tearing Rhinorrhea, congestion, tearing Facial flushing, GI symptoms Facial flushing, GI symptoms  Need to avoid aspirin and NSAIDs

28. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Drugs and Food Additives (cont’d)  β-blockers may trigger asthma Propanolol (Inderal) Propanolol (Inderal) Timolol (Timoptic) Timolol (Timoptic)  Inhibit adrenergic stimulation of bronchioles and prevent bronchodilation

29. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Drugs and Food Additives (cont’d)  Sulfites may trigger asthma Used in dried fruits, wine, beer, shrimp, and salad bars Used in dried fruits, wine, beer, shrimp, and salad bars Used as preservative in eye solutions, IV corticosteroids, inhaled bronchodilators Used as preservative in eye solutions, IV corticosteroids, inhaled bronchodilators Can cause breathing difficulty for many people with asthma Can cause breathing difficulty for many people with asthma

30. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Drugs and Food Additives (cont’d)  Food allergies may cause asthma symptoms Avoidance diets Avoidance diets Rare in adults Rare in adults

31. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Gastroesophageal Reflux Disease  >75% of people with asthma experience GERD  Those with severe asthma more likely to have GERD

32. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Gastroesophageal Reflux Disease (cont’d)  Chronic backward flow of stomach acid into esophagus  Causes burning sensation called heartburn

33. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Gastroesophageal Reflux Disease (cont’d)  Exact mechanism causing asthma is unknown Reflux of acid could be aspirated into lungs, causing vagal stimulation and bronchoconstriction Reflux of acid could be aspirated into lungs, causing vagal stimulation and bronchoconstriction Treated with H 2 -histamine blockers and proton pump inhibitors Treated with H 2 -histamine blockers and proton pump inhibitors

34. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Health Promotion - GERD  Raise head of bed by 6 inches to allow gravity to keep contents in stomach  Eat meals at least 3-4 hours before lying down, and avoid bedtime snacks  Eat smaller meals  Maintain healthy weight to eliminate intra- abdominal pressure caused by extra pounds

35. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Health Promotion - GERD (cont’d)  Limit fatty foods, chocolate, peppermint, coffee, tea, colas and alcohol - all of which relax the lower esophageal sphincter (LES)  Limit tomatoes and citrus fruits or juices, which contribute additional acid that can irritate the esophagus  Do not smoke, which also relaxes the LES  Wear loose belts and clothing

36. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Triggers of Asthma Emotional Stress  Psychological factors can worsen the disease process Attacks can trigger panic and anxiety Attacks can trigger panic and anxiety Extent of effect is unknown Extent of effect is unknown

37. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Case Study  A 30-year-old African America woman comes to the emergency department (ED) with severe wheezing, dyspnea, and anxiety

38. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Case Study (cont’d)  Her history indicates she had a recent cold that did not resolve had a recent cold that did not resolve had taken a new job at a dry cleaners and laundromat had taken a new job at a dry cleaners and laundromat was having regurgitation of food after eating which she related to the stress from her recent divorce was having regurgitation of food after eating which she related to the stress from her recent divorce

39. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Case Study (cont’d)  Her history indicates: she was upset that her children had just brought home a stray cat she was upset that her children had just brought home a stray cat she did not know if she was allergic to it she did not know if she was allergic to it

40. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Case Study Health Promotion Strategies  Teach patient to identify and avoid possible triggers Upper respiratory tract infection Upper respiratory tract infection Work environment Work environment Stress and GERD Stress and GERD

41. Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. All rights reserved. Case Study Health Promotion Strategies (cont’d)  Teach patient to identify and avoid possible triggers (cont’d) Cat?? Cat??  Review medication regimen