Adult Asthma

Asthma, in all ages, is a chronic respiratory disease characterized by:
  1. airflow obstruction that is reversible,
  2. airway inflammation, and
  3. increased airway responsiveness to a variety of stimuli.
The degree of hyperresponsivness is closely linked to the extent of inflammation and manifestation of symptoms.  Asthma in the adult client can present either as a denovo occurrence or as a continuation of a disease entity that began earlier in life.  Incomplete reversibility becomes common as the patient/client becomes older especially when symptoms have been severe or persistent and some develop chronic airflow obstruction (COPD).  This coexistence of asthma and COPD creates diagnostic confusion, especially in clients who have a history of smoking.

Signs/Symptoms
    The clinical hallmark symptom is wheezing, but cough may be the per dominant symptom making asthma commonly misdiagnosed as recurrent pneumonia, chronic bronchitis or gastric reflux.  Other common symptoms are:
        *  periodicity of symptoms                                *  nocturnal attacks
        *  prolonged expiration                                     *  cyanosis
        *  hyperresonace                                              *  tachycarida
        *  decreased breath sounds                               *  accessory muscle use
        *  chest tightness                                               *  dyspnea

    Under treatment and inappropriate therapy are major contributors of asthma morbidity and mortality in the United States.
        +  Hospital izations due to asthma are preventable or avoidable.
            -  Asthma is the 3rd leading cause of preventable hospitalization
            -  There are approx. 470,00 hospitalizations and more than 5,000 deaths annually
            -  Only 28% of adults hospitalized have written actions plans.

Four Goals of Asthma Management

    1.  Educate patients for a partnership in care.
            Much of the daty-to-day responsibility for management lies with patient and the patient's family or caregiver.

    2.  Monitoring
            of signs and symptoms, lung function (peak expiratory flow [PEF]) treatment effectiveness, and ability to follow the
           treatment plan.  However, for some patient, home PEF monitoring may be limited by age related factors.  Symptom
            monitoring and use of a daily diary may help this patient assess their progress and become more sensitive to
            worsening asthma.

    3.  Environment Control
            It appears the same factors trigger acute exacerbation of asthma among adult, although sensitivity to inhaled allergens
            is less prevalent in adults.

    4.  Pharmacology Therapy
            A stepwise approach to drug therapy is appropriate for asthmatics of all age groups, with special considerations
            for the older patient due to an increased likelihood of coexisting diseases and drug interactions
 

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This web site was developed as part of the requirements for the course Nursing and the Internet offered through
Webster Universityat its Kansas City Metropolitan campus