Asthma: Types and Triggers (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 Hi. Welcome to our respiratory video series. In this one, we'll take a look at asthma. Now asthma is a chronic condition. That means you don't just have it once and you're done. This is a chronic condition and it causes inflammation and narrowing of the bronchial tubes. Okay, those are the passageways that allow air to enter and leave your lungs. So the first thing when you're thinking about asthma, it's chronic and it has inflammation and bronchoconstriction.

    00:30 So, asthma affects a large amount of Americans, over 26 million Americans have asthma and it's one of the most common childhood illnesses. Now the officials that help us with asthma, they've given us these 6 categories. So, I'm not going to talk in depth about them but just kind of give you an idea. Not all asthma is exactly the same. It might be adult-onset asthma.

    00:54 Now that means it didn't kick in, you didn't know that you had asthma until you're an adult.

    00:59 Now there's also some overlap between asthma and chronic obstructive pulmonary disease or COPD. Now you can have non-allergic asthma and allergic asthma. So those are another 2 categories. Exercise-induced bronchoconstriction is like, we call it, exercise-induced asthma.

    01:17 You heard that by some different names, but that essentially means that when a patient exercises they have those bronchospasms. So, they're a little more simply treated because if we know they're going to exercise, they can take some medication before they exercise about 15 minutes and that should help them minimize the risk of an attack. Now lastly is occupational asthma, something you've been exposed to has caused the asthma. So that's just to give you an idea of 6 different kinds or types of asthma as they're officially identified. Now let's talk about what things are common and with asthma you usually have a persistent cough especially at night, it gets worse at night. Also have it when you exercise or when you laugh. This is what happens when someone has asthma. So, that's, you know you got a really good when you make them cough. I guess that's not so nice to do in an asthma patient, but have that in your mind. It's a persistent cough. There's some annoying times; nighttime, exercise, or after a laughing. Now they can also have shortness of breath, that kind of makes sense because of what's going on in their airways, they'll find themselves short of breath. They might not be able to catch their breath so their chest feels very very tight. Now you know there's wheezing when breathing and it's especially on exhale so, that's really not a great impersonation but it kind of gives you a feel but particularly on breathing out or exhale is when you hear that wheezing. And oftentimes if the asthma is significant enough I don't need a stethoscope to hear it, you can hear it just with your ear. Now lastly is bronchospasm. Now we unpacked that in a little more detail in other video series, but we're going to touch on it here because it's a major part of asthma. Now, this is an example of a normal airway and then in an asthmatic airway when it's not under attack and in asthmatic airway when it is under attack. So, take a look at that asthmatic airway. We are looking at the bronchiole, you see that it's got smooth muscle in the wall and wrapped around it, that's what those darker bands are. They follow that bronchiole. Remember that's the little one, they're smaller than bronchi because when you think back on your airway, you've got the trachea, breaks off into bronchi. The bronchi goes to each of the lungs, the right and the left lung, and then as it gets smaller you get in to the bronchioles then all the way down to the alveoli. So at the end of those tubes, you see alveoli in each of the 3 examples. So that part is the same. Each of the 3 examples has alveoli at the end, you see smooth muscle around the outside of the airway and you see it in the wall. Yup, all 3 of those are the same. Here's where they look vastly different. So look at the normal airway compared to someone who has asthma, not under attack but you can see that the airway is smaller. Right? They already have a smaller airway thing seem kind of swollen up.

    04:20 Now look at the asthmatic airway during an attack. It's even smaller, it's tighter, and look at those bands around the outside. Feel like they're really squishing that airway, that's because they are. That smooth muscle that's there, when it constricts it makes it really tight. That's why they feel like their chest is tight because their airways are being squeezed. So, whether you can see it in this picture or not, there is a significant difference between the asthmatic airway during an attack and a normal airway. And your patient really feels like they cannot catch their breath, everything is super tight. This is scary. This is your brain telling you "Hello, if we don't do something we're gonna die." So that's why patients in an asthma attack, very important that you as a nurse remain calm but stay proactive in helping the patient get help and restore that airway again. So make sure you've got this solid. You might want to pause a video and take some time here and make sure you're very clear where smooth muscle is. Yeah, it's those bands wrapped around. It's also in the wall of the airway. The difference between an asthma airway and a normal airway, well look at that, they're even different when the patient isn't having an attack. Their airways are already smaller. When they do have an attack, it becomes even smaller. So make sure you have a clear visual in your mind before you press on with us to the rest of the series. Now common triggers, everyone can have some different triggers. So what may trigger one person won't trigger another, but it's really important that every patient know what their particular triggers are. That might be an allergen, could be exercise, illness, weather, extreme temperatures, stress, smoke, or even some foods can set off an asthma attack. So we're talking about bronchospasm. Remember that's a sudden ___, that's a tightening or constriction of the muscles in the walls of the bronchioles and that smooth muscle is what does it. It's usually caused by some type of inflammatory response when we're talking about the airways. Now you have smooth muscles throughout your body in the hollow organs but we're focusing in asthma with the ones that are in your airways. So it's usually some type of inflammatory response, an allergy, an infection, or overexertion in exercise. Now bronchospasm can quickly become a life threatening emergency. That's why as if you're with somebody in the community that's having a bronchospasm or you're in your familiar healthcare setting, it still can become a life threatening emergency.

    06:56 Now watch your patient closely. See how hard it is for them to breath. Right? Are they using all their accessory muscles around here and that will really demonstrate if a patient is using their accessory muscles to breathe that means they are trying to get every muscle in their trunk engaged and involved in helping them breathe. It is painful to see but it's a sign to you as a healthcare provider that "man, this patient is in severe distress" if they had to get down to using their accessory muscles to breathe.

    About the Lecture

    The lecture Asthma: Types and Triggers (Nursing) by Rhonda Lawes, PhD, RN is from the course Obstructive Respiratory Disorders (Nursing).

    Included Quiz Questions

    1. Asthma
    2. Chronic obstructive pulmonary disease (COPD)
    3. Influenza
    4. Shunting
    1. Over 26 million
    2. Over 26,000
    3. Over 260,000
    4. Over 2.6 million
    1. Allergic asthma
    2. Exercise-induced bronchoconstriction (EIB)
    3. Occupational asthma
    4. Adult-onset asthma
    5. Respiratory syncytial virus (RSV)
    1. Persistent cough, especially at night with exercise and laughing
    2. Shortness of breath
    3. Wheezing with breathing (especially on exhale)
    4. Bronchospasm
    5. Lower extremity swelling

    Author of lecture Asthma: Types and Triggers (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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