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Asthma |
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| Learning
Objectives
Upon completing the course you'll be able to:
Chapter 1: Definitions
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Explain airway pathology in
asthma.
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Describe the relationship of
airway pathology to disordered lung function.
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List and explain all forms of
airflow imitation in asthma.
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Based on the functional
consequences of airway inflammation, provide an operational description of
asthma.
Chapter 2: Epidemiology
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Describe the prevalence of
asthma based on genetic factors, environmental factors, allergens, and
population characteristics.
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Describe the mortality and
morbidity of asthma.
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Describe the evolution of
asthma from infancy to adulthood.
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Formulate a respiratory health
survey questionnaire.
Chapter 3: Risk Factors
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Identify two predisposing
factors that lead to the development of asthma.
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Identify four causal factors
that lead to the development of asthma.
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Identify five contributing
factors that lead to the development of asthma.
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Identify six factors that
exacerbate asthma.
Chapter 4: Mechanism of Asthma
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Discuss the mechanism of airway
inflammation in asthma.
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Explain how nonspecific stimuli
provoke reflex bronchoconstriction.
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Describe four characteristics
symptoms of asthma.
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List four factors that may
contribute to airflow limitation in asthma.
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Describe nocturnal asthma.
Chapter 5: Diagnosis and Classification
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List five symptoms that would
lead to a clinical diagnosis of asthma.
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Formulate five questions of the
patient in considering the diagnosis of asthma.
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Describe how measurements of
airflow limitation, its reversibility and its variability can help in
establishing a diagnosis of asthma.
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Describe two methods (FEV1 and
FVC) used to assess the level of airflow limitation.
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Describe the additional factors
to be considered in the diagnosis of childhood asthma in the elderly,
occupational asthma, seasonal asthma, and cough variant asthma.
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Explain the classification of
asthma on the basis of etiology, severity and pattern of airflow limitation.
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Describe clinical features
before treatment and daily medication required to maintain control of asthma
classified by its severity.
Chapter 6: Prevention
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Discuss the goal of primary
prevention of asthma.
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Discuss seven primary
prevention strategies for asthma.
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Explain how the domestic mite
allergen is a major causal risk factor for asthma.
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Describe five future programs
for the primary prevention of asthma.
Chapter 7: A Six-Part Asthma Management Program
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List seven goals for successful
management of asthma.
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Educate patients to develop a
partnership in asthma management.
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Assess and monitor asthma
severity with measurements of symptoms and measurements of lung function.
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Interpret PEF measurements for
management of asthma.
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Describe six nonpharmacological
secondary prevention measures to avoid or control asthma triggers.
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Establish a medication plan for
long-term management of asthma using controller medications and reliever
medications.
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List eight parameters that
would define control of asthma.
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Describe a four-step treatment
approach to the long term management of asthma.
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Ask six questions of the asthma
patient to establish the diagnosis and classify the severity of asthma.
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Describe the four-step
treatment approach for infants and young children in the management of
asthma.
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List eight objectives for the
control of asthma in infants and young children.
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List four categories of
patients who are at high risk of asthma-related death.
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Classify 11 symptoms into mild,
moderate and severe exacerbations of asthma.
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Describe treatment for home
management of asthma exacerbations.
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Describe in a flow chart format
the management of exacerbation of asthma in a hospital environment.
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List eight factors that would
indicate the need for close and continuous supervision of the asthma patient
in a hospital.
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List three criteria for
admitting the asthma patient to the intensive care unit.
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List nine criteria to determine
if the patient can be discharged from continuous supervision in a hospital.
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Explain special considerations
required in managing asthma in relation to pregnancy, physical activity,
surgery, occupational asthma, and aspirin-induced asthma.
Learning
Objectives
To
assess the effectiveness of the course material, we ask that you evaluate your
achievement of each learning objective on a scale of A to D (A=excellent, B=good,
C=fair, D=unsatisfactory). Please
indicate your responses next to each learning objective and return it to us with
your completed exam.
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| Course
Outline |
 | Airway pathology in asthma; pathological features of asthma
death.
| Relationship of airway pathology to disordered lung
function: airway hyperresponsiveness.
| Airflow limitation: acute bronchoconstriction; swelling of
the airway wall; chronic mucus plug formation; airway wall remodelling.
| Definition of asthma: mechanisms underlying the definition
of asthma.
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Prevalence:
| Defining populations: affluent populations; partly affluent
populations; nonaffluent populations;
migrants;
| Defining countries: developed country; developing country.
| Defining asthma for epidemiological studies measurements of
airway hyperresponsiveness.
| Evaluation of etiological factors.
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Mortality of asthma
| Asthma deaths in 5- to 34-years olds.
| Morbidity: Quality of life, hospital admissions.
| Natural history of asthma-Infancy, Childhood, Adulthood. |
| Research questions, needs assessment checklist for health
authorities. |
| Risk factors involved in the development of asthma |
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Predisposing Factors
| Atopy and inheritance of asthma.
| Genetic control of IgE synthesis.
| Genetic control of the immune response,
| Race and asthma.
| Causal factors
| Indoor allergens- domestic mites, animal allergens.
| Outdoor allergens- pollens, fungi, occupational sensitizers.
| Drugs and food additives.
| Contributing factors
| Smoking-passive smoking, active smoking, air pollution.
| Outdoor pollutants, indoor pollutants.
| Viral respiratory infections.
| Small size at birth.
| Diet. Parasitic infections.
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Risk factors that cause asthma exacerbations: Triggers.
| Allergens.
| Air pollutants.
| Exercise and hyperventilation.
| Weather changes.
| Sulfur dioxide.
| Foods, additives,drugs.
| Extreme emotional expression.
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Other factors that may exacerbate asthma.
| Airway inflammation in asthma
| Immunologic mechanisms. Inflammatory mediators, IgE-dependent,
T-lymphocyte-dependent mechanisms.
| IgE-independent, T-lymphocyte-dependent mechanisms.
| Adhesion molecules. Constitutive cells.
| Neural control of airways.
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Asthma symptoms:
| Cough, chest, tightness, wheezing, and dyspnea.
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Airflow limitation in asthma
| Factors that contribute to airflow limitation in asthma,
including direct and indirect (neural) contraction of
smooth muscle, edema, mucus plug formation, and airway wall remodeling.
| Being awakened at night by cough, wheeze or breathlessness,
or experiencing chest tightness at night or first thing in the morning is
characteristic of asthma. |
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Clinical diagnosis:
| History and measurement of symptoms
| Physical examination
| Measurements of lung function
| Measurements of allergic status
| Differential diagnosis of obstructive airway disease
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Always think
| Is obstruction localized or generalized.
| Measurements of lung function
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Childhood asthma
| cystic fibrosis;
| recurrent milk inhalation;
| primary ciliary dyskinesia syndrome;
| primary immune deficiency;
| congenital heart disease;
| congenital malformation causing narrowing of intrathoracic
airways; and
| foreign body aspiration.
| Asthma in the elderly.
| Occupational asthma.
| Seasonal asthma.
| Cough variant asthma.
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Classification of asthma
| Etiology; severity.
| Time trends of airflow limitation
| Severe persistent;
| moderate persistent
| mild persistent intermittent.
| Inhaled corticosteroid and long-acting bronchodilator;
inhaled short-acting B2-agonist.
| Prevent development of the condition of asthma.
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Primary prevention strategies:
| Indoor Environments
| Tobacco Smoking
| Outdoor Environments
| Workplace Environments
| Small Size at Birth
| Infections
| Nutrition and Diet
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Goals for successful management of asthma
| Achieve and maintain control of symptoms
| Prevent asthma exacerbations
| Maintain pulmonary function as close to normal levels as
possible
| Maintain normal activity levels, including exercise.
| Avoid adverse effects from asthma medications
| Prevent development of irreversible airflow limitation
| Prevent asthma mortality.
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Avoid or control asthma triggers:
| Avoid or control asthma triggers: nonpharmacological
secondary prevention
| Environmental control measures-domestic mites, animal allergens,
cockroach allergen, fungi.
| Avoidance of outdoor allergens
| Avoidance of indoor air pollutants
| Avoidance of outdoor air pollutants
| Avoidance of occupational exposure
| Food avoidance
| Avoidance of certain drugs
| Vaccination
| Specific immunotherapy
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Establish diagnosis
| Ask patient or parents: does the patient have?
| Recurrent attacks of wheezing?
| Troublesome cough or wheeze at night or early in the morning?
| Cough or wheeze after exercise?
| Cough, wheeze, or chest tightness after exposure to airborne
allergens or pollutants?
| Colds that “go to the chest” or take more than 10 days to clear
up?
| Antiasthma medicine?
| How frequently does the patient take it?
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Criteria for admission to intensive care unit:
| A lack of response to initial therapy in the emergency
department and/or rapidly worsening asthma.
| Presence of confusion, drowsiness, other signs of impending
respiratory arrest, or loss of consciousness.
| Impending respiratory arrest.
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Outcome control of asthma
| Minimal (ideally no) chronic symptoms, including nocturnal
symptoms
| Minimal (infrequent) episodes
| No emergency visits
| Minimal need for prn B2-agonist
| No limitations on activities including exercise
| PEF circadian variation <20%
| (Near) normal PEF
| Minimal (or no) adverse effects from medicine
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Severity of asthma exacerbations
| Breathless.
| Talks in sentences.
| Alertness.
| Respiratory rate.
| Accessory muscles and suprasternal retractions.
| Wheeze.
| Pulse/min.
| Pulsus paradoxus.
| PEF.
| PA2 (on air).
| SAO2% (on air)
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Special considerations:
| Pregnancy
| Surgery
| Physical activity
| Rhinitis, sinusitis, and nasal polyps
| Allergic rhinitis
| Sinusitis
| Nasal polyps
| Occupational asthma
| Respiratory infections
| Gastroesophageal reflux
| Aspirin-induced asthma
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| Customer Comments About Our Courses |
| The course is over all
excellent, very professional.
T.C., Poway, CA
Wonderful course. I had a special interest in
this information as I have two children with asthma.
L.B., Chino Hills, CA
Very appropriate pertaining to NIH guidelines for
practice. Well done!
A.S., Lake Forest, CA
Extremely comprehensive–can be a very useful
tool for those clinicians dealing hands on with asthma patients on a frequent
basis.
C.W., Palo Alto, CA
Because I have ASTHMA & also a grandchild
suffers ASTHMA, I found this extremely educational, informative and helpful.
D.K., Templeton, CA
Very informative & helpful–were pass
informative to family (son-in-law) has severe asthma & needs is encouraged to
learn more.
S.G., S. San Francisco, CA
Very good course–content with great adherance
to NIH guidelines.
S.W., Hudsonville, MI |
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