2. Asthma Triggers and Health Promotion Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

3. Significance Asthma affects about 16 million Americans Adult females have a greater prevalence of asthma than males Female death rate greater than males Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

4. Triggers Bring on symptoms of asthma Different from person to person Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

5. Triggers Asthma cannot be cured, but can be managed Goal in asthma - minimize exposure to triggers Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

6. 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  Nonseasonal forms of asthma may be year round (perennial) Related to allergens such as dust mites, molds, animals Cockroaches Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

7. Nursing Management Health Promotion - Allergens Dust mites like warm places  Bedding, upholstered furniture, carpeting, and stuffed toys Control dust and dust mites  Put mattresses and pillows in special allergen-proof covers  Wash bedding every week in hot water Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

8. Nursing Management Health Promotion - Allergens Control dust and dust mites  Remove dust collectors from the bedroom  Dust woodwork and wash curtains often  Use a damp mop on floors instead of sweeping Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

9. Nursing Management Health Promotion - Allergens Control dust and dust mites  Vacuum carpets/rugs weekly  Avoid using humidifiers and use dehumidifiers in damp parts of the house  Replace air conditioner and furnace filters monthly Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

10. Nursing Management Health Promotion - Allergens Control mold indoors  Basements, kitchens, and bathrooms should be kept as clean and dry as possible.  Humidifiers and vaporizers should be avoided. Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

11. Nursing Management Health Promotion - Allergens Control mold outdoors  Stay inside in air conditioning on damp, windy days Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

12. Nursing Management Health Promotion - Allergens Control mold  Keep bathroom dry by using an exhaust fan or dehumidifier  Clean sinks, tubs, and showers with bleach solution (1 part bleach, 3 parts water)  Limit house plants  Clean spacers and nebulizers often Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

13. Nursing Management Health Promotion - Allergens Control pollen  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 counts are lower in the evening so that is a better time to go outdoors Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

14. Nursing Management Health Promotion - Allergens Control pollen  During allergy season, use air conditioning instead of opening windows  Change the air conditioner filter monthly  Shower or bathe after being outdoors Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

15. 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 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

16. Triggers of Asthma Exercise Induced or exacerbated after exercise  Typically occur after vigorous exercise  Pronounced with exposure to cold air Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

17. Nursing Management Health Promotion - Exercise Medications to promote bronchodilation  10-20 minutes before exercise  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 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

18. Triggers of Asthma Air Pollutants Can trigger asthma attacks  Cigarette or wood smoke  Vehicle exhaust  Elevated ozone levels  Sulfur dioxide Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

19. Triggers of Asthma Health Promotion - Air Pollutants Ozone alert days  Noted in newspaper  Minimize outdoor activity during these times Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

20. Nursing Management Health Promotion - Smoking Do not allow smoking in home or car Do not use wood burning stoves or fireplaces Avoid campfires Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

21. Triggers of Asthma Occupational Factors Most common form of occupational lung disease  Exposure to diverse agents Arrive at work well, but experience a gradual decline during day Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

22. Nursing Management Health Promotion – Occupational Factors Nurse needs to obtain a health history  Assess if symptom-free when not at work Use masks and proper ventilation Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

23. Triggers of Asthma Respiratory Infection Major precipitating factor of an acute asthma attack  ↑ inflammation hyperresponsiveness of the tracheobronchial system  Viruses cause asthma by activating immune system Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

24. 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 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

25. Triggers of Asthma Nose and Sinus Problems Allergic rhinitis and nasal polyps  Large polyps are removed  Sinus problems are usually related to inflammation of the mucous membranes Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

26. Triggers of Asthma Drugs and Food Additives Asthma triad: nasal polyps, asthma, and sensitivity to aspirin and NSAIDs Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

27. Triggers of Asthma Drugs and Food Additives Symptoms related to asthma triad  Wheezing develops in about 2 hrs  Rhinorrhea, congestion, tearing  Facial flushing, GI symptoms Need to avoid aspirin and NSAIDs Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

28. Triggers of Asthma Drugs and Food Additives β-blockers may trigger asthma  Propanolol (Inderal)  Timolol (Timoptic) Inhibit adrenergic stimulation of bronchioles and prevent bronchodilation Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

29. Triggers of Asthma Drugs and Food Additives Sulfites may trigger asthma  Used in dried fruits, wine, beer, shrimp, and salad bars  Used as preservative in eye solutions, IV corticosteroids, inhaled bronchodilators  Can cause breathing difficulty for many people with asthma Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

30. Triggers of Asthma Drugs and Food Additives Food allergies may cause asthma symptoms  Avoidance diets  Rare in adults Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

31. Triggers of Asthma Gastroesophageal Reflux Disease >75% of people with asthma experience GERD Those with severe asthma more likely to have GERD Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

32. Triggers of Asthma Gastroesophageal Reflux Disease Chronic backward flow of stomach acid into esophagus Causes burning sensation called heartburn Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

33. Triggers of Asthma Gastroesophageal Reflux Disease Exact mechanism causing asthma is unknown  Reflux of acid could be aspirated into lungs, causing vagal stimulation and bronchoconstriction  Treated with H 2 -histamine blockers and proton pump inhibitors ma Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

34. 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 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

35. Triggers of Asthma Health Promotion - GERD 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 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

36. Triggers of Asthma Emotional Stress Psychological factors can worsen the disease process  Attacks can trigger panic and anxiety  Extent of effect is unknown Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

37. Case Study A 30-year-old African America woman comes to the emergency department (ED) with severe wheezing, dyspnea, and anxiety Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

38. Case Study Her history indicates she  had a recent cold that did not resolve  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 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

39. Case Study Her history indicates:  she was upset that her children had just brought home a stray cat  she did not know if she was allergic to it Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

40. Case Study Health Promotion Strategies Teach patient to identify and avoid possible triggers  Upper respiratory tract infection  Work environment  Stress and GERD Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

41. Case Study Health Promotion Strategies Teach patient to identify and avoid possible triggers  Cat?? Review medication regimen Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.