Review of Asthma: Bronchoconstriction and Airway Inflammation (Nursing)

00:00 Now let's take a look at asthma.

00:02 It's pretty common, you see it diagnosed in children.

00:05 I'm sure some of you watching this video today have either experienced asthma in yourself or someone in your life has asthma.

00:13 Now there's two things I want you to underline first off in your notes.

00:17 First is bronchoconstriction, that word.

00:19 Put a big underscore around it, circle it and star it.

00:23 Because that's one-half of the problem with asthma.

00:27 The other half of the problem is inflammation.

00:31 Inflammation is an immune response and it's triggered by these allergens that you're exposed to.

00:36 Now, each one of us has specific allergens that cause that inflammatory response in our body.

00:42 It may be something like dust or maybe it is pet dander or something outside when a certain flower or trees are blooming.

00:50 But it's really important part of educating your patient for them to identify what are their triggers.

00:56 We can try to avoid them or at the very least pre-medicate before they're exposed to their triggers.

01:01 So what happens when you get exposed to something that you're allergic to, that you have inflammatory response to, is that the airways become inflammed.

01:11 Inflammed airways are smaller airways and that makes breathing more difficult.

01:16 So the bronchoconstriction, when that thing's clamping down.

01:20 But inflammation means that those airways are even becoming smaller in diameter on the inside, so it is definitely double trouble.

01:28 Now it don't just become inflammed and smaller and what we have left to work with gets filled with all this excess, nasty mucus.

01:36 So you have a narrowed airway, you got the vessels clamping down, you've got that smooth muscle clamping down, the airways are inflammed, narrowed and full of mucus.

01:47 Okay, so I wanna give you a few more of the steps and exactly what happens in your body when you're exposed to an allergen and how you end up with those airways that are smaller and full of gunk.

01:59 When you understand how this happens, it'll make more sense to you on why we choose which medications that we do to treat asthma.

02:06 So you go for a walk, you're exposed to an allergen, some flowering tree and you start to get that feeling where you're having a hard time breathing.

02:15 But what's going on? The allergen is breathed into your body and it binds to IgE antibodies on mast cells.

02:23 Now when IgE antibodies connect to the mast cells, then the mast cells, they release their mediators: histamines, leukotrienes, interleukins and prostaglandins.

02:36 Now those first two might sound kinda familar to you.

02:39 Histamines are the one that cause all that response in your body.

02:43 That's why we take some other medications called antihistamines for allergic reactions.

02:48 Antihistamines will block the histamines that's released from these mast cells from connecting to the receptors.

02:56 Okay, so you've exposed to an allergen, Step 1.

03:00 Then when those allergens combine the IgE and connect the mast cells, mast cells release those beasts: histamine, leukotrienes, interleukins and prostaglandins.

03:10 So, when these things are released in your body, that's what causes the bronchoconstriction, the inflammatory cells to be infliltrated, now you got the eosinophils, leukocytes and macrophages.

03:21 These all happens, boom! in seconds.

03:25 But I want you to get the process: exposed to the allergen, IgE antibodies connect to that to the mast cell, mast cells then release their mediators.

03:34 The mediators are what wreak havoc if they can hit their receptors.

03:39 And then those inflammatory cells respond and release their cytokines and leukotrienes and interleukins.

03:44 So it's a chain effect on what goes on.

03:47 End result? the airways are hyperactive, inflammed and have excess mucus.

03:53 Now, is it important that you memorize each one of these steps? Not really at this point.

03:58 I just want you to understand the concept, the inflammatory part of asthma.

04:03 They're exposed to an allergen and that with IgE antibodies, hook into those cells, spraying out their nasty beast and that's what ends up with the hyperreactive, inflammed, excess mucus in our airways.

04:18 Okay.

04:19 Now when we talked about some of the other medications we talked about, we can intervene certain steps, we can prevent this bad result at the end.

04:27 That's the takeaway point from this topic.

04:30 Knowing that these things are released, things follow a very sequential order, then you'll understand when we use these specific medications, we can stop that reaction and have airways that are more open with less mucus because that's our goal.

04:46 Now if you've ever experienced asthma, I want you to get a little feel for what it feels like for the patient.

04:52 If you have experienced asthma, you're gonna know exactly what I'm talking about.

04:57 Because when they start to have triggers that can lead to a bronchospasm, I don't want you to think sometimes it's just like a short, this can't really catch their breath.

05:07 No, this is intense and the feeling of not being able to breathe will cause panic in even the most calm patient.

05:16 Because these airways before they even are exposed to allergen are probably already narrowed.

05:21 Their chest feels really tight is how people explain it to us.

05:26 It's hard for them to catch their breath or to take a deep breath in and their breath sounds will have wheezes, or this high pitched whistling sounds when they try to take a breath.

05:35 (wheeze) They'll sound kind of like that.

05:39 Sometimes you'll need a stethoscope to hear them but usually when someone's having a pretty serious asthma attack, you can hear it even without a stethoscope.

05:47 I've been at the gym with someone who's having an asthma attack while we're working out and I promise you, even on my bad side, I can hear somebody wheezing a ways away.

05:57 So I'm always asking, do you have your medicine? Do you have your inhaler? So recognize, be alert and watch for those signs and symptoms of a patient having an asthma attack.

06:07 They also might have this cough that they just can't get rid of during this attack.

06:11 It'll be irritated, not because those airways are being inflammed.

06:15 They also might feel dizzy or light headed which is an especially bad combination at the gym.

06:22 So why is it important that you learn all the signs of an asthma attack? Or when a patient is starting to go into an asthma attack? Because when we give them medications to treat that attack, these things should be lessened.

06:36 It is very important as a nurse that you know how to evaluate the effectiveness of medication treatment plans.

06:42 So if I have an asthma patient, who's feeling like this, I'm gonna ask after they've taken their medication or when we're working through the process with him, "Do you feel like you can catch your breath better now?" I'll be listening to see if wheezing is going away.

06:57 I'll ask him if their chest still feels as tight.

07:00 I'll be observing to see if that cough has lessened.

07:03 So you always want to understand what are the signs and symptoms when things are not going well for you patient so you know which medication to pick and so you know how to evaluate if that medication was effective.