This offering expires in 2 years: September 11, 2008
The goal of this continuing education offering is to provide nurses with current information on adult onset asthma. After reading this article, you will be able to:
1. Discuss triggers that can cause asthma attacks in adults.
2. Describe methods of diagnosing asthma in adults.
3. Differentiate quick-acting and long-acting medications used in asthma treatment.
You can earn 1.5 contact hours of continuing education credit in three ways: 1) For im-mediate results and certificate, go to www.advanceweb.com/nurses. Grade and certificate are available immediately after taking the online test. 2) Send this answer sheet (or a photocopy) along with the $8 fee (check or credit card) to ADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406. Make checks payable to Merion Publications Learning Scope (any checks returned for non-sufficient funds will be assessed a $25 service fee). 3) Fax the answer sheet (available with credit card payment only) to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better.
Merion Publications Inc. is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association (No. 011-3-H-04), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Merion Publications Inc. also is approved as a provider by the California Board of Registered Nursing (No. 13230) and by the Florida Board of Nursing (No. 3298).
Helena, a 52-year-old female who has had allergies most of her life, is admitted to your unit with a diagnosis of adult onset asthma. She presented to the emergency department complaining of frequent episodes of rhinitis, coughing, expectoration of large amounts of mucus and, more recently, wheezing and chest pain.
Helena reports she has been treated for allergies for more than 40 years, including a desensitization series when she was a teen. Over the past year, she has noted an increase in symptoms, with marked dyspnea and audible wheezing.
What Are the Causes?
Adult onset asthma is the development of asthma for the first time in someone of middle age or older. The usual symptoms of asthma generally are present: varying degrees of dyspnea, wheezing and productive cough.
Adult onset asthma may or may not be caused by allergies. Individuals who had allergies as children or young adults with no asthma symptoms could develop asthma as older adults. In other instances, adults become sensitized to everyday substances found in their homes or food and suddenly begin to experience asthma symptoms.
Several factors make a person more likely to develop adult onset asthma. Women are more likely to develop asthma after age 20 related to hormonal fluctuations. For others, obesity, allergy to cats, and exposure to cigarettes, molds, dust, feather bedding, perfume and other environmental substances appear to significantly increase the risk of developing asthma as an adult. Prolonged exposure to certain workplace materials such as animal products, certain forms of plastic, wood dust or metals may set off asthma symptoms in adults. Several common medications can trigger or exacerbate asthma, including aspirin and other NSAIDs, oral beta-blockers for hypertension and heart disease, and beta-blocker eye drops for glaucoma.
When people with asthma are exposed to their triggers, their immune systems start trying to fight off the allergens. When breathing passages become irritated or infected, an asthma attack is triggered.
In most cases, asthma is caused by inhaling an allergen that sets off a chain of biochemical and tissue changes, leading to airway inflammation, bronchoconstriction and wheezing. Because avoiding (or at least minimizing) exposure is the most effective way to treat asthma, it is vital to identify which allergen or irritant is causing asthma symptoms.
An asthma attack occurs when the bronchioles become inflamed and constricted after being exposed to a trigger. The asthma trigger enters the airways and goes from the trachea into the bronchi and bronchioles. The tissues inside these tubes become inflamed. The muscles on the outside of the airways constrict, causing the airways to narrow. In response to the irritant, the cells lining the airways develop mucus in copious amounts, and the airways become swollen.
This swelling causes the airways to narrow even more, resulting in more inflammation and swelling of the lining of the air passages. This vicious cycle makes breathing difficult (like breathing through a straw for a long time) and noisy, and it causes coughing.
Asthma attacks do not always occur immediately after someone is exposed to a trigger. Depending on the person and the trigger, an attack can happen hours or even days later. It may occur during either the day or night, and attacks may last anywhere from a few minutes to days.
The more inflammation there is, the longer the attack will last. Attacks that last for days can be hazardous for a number of reasons: the person is unlikely to maintain adequate nutrition and fluid levels; oxygen levels may become dangerously low and carbon dioxide levels may get dangerously high.
Asthma is more likely to develop in individuals with a family history of asthma.1 Early exposure to tobacco smoke has been suspected of increasing the risk for asthma.2
Several biological and environmental factors can trigger an asthma attack. Table1 lists the triggers most likely to start an asthma attack.
During an asthma attack, the tissues lining the airways become inflamed. The top layer of the lining of the airways can become damaged and shed cells. New cells are laid down on the airway linings, a process called remodeling.
This damage results in the development of easily irritated bronchial tubes, which is called hyper-responsiveness. This condition causes the lungs to become excessively "twitchy" and react (or overreact) to previously non-allergic stimuli, such as cold weather, pollution, dry air and chemical odors. The bronchial tubes react by going into spasm, which leads to the symptoms of dyspnea, coughing, wheezing and chest tightness.
Inhaling smoke from cigarettes or fires harms the airways and is especially hard on the airways of people with asthma. In fact, cigarette smoking is responsible for more than half the cases of asthma in people over age 40.2
The onset of asthma may be seasonal. Heat, humidity, air pollution and higher pollen counts in the summer can trigger an asthma episode in some people. In others, the wet conditions of the spring and fall may encourage the growth of certain molds that can trigger an attack. The buildup of smoke, animal dander and mites in a sealed house in the winter also can aggravate asthma.
Asthma symptoms can be triggered by a variety of health-related factors. For example, respiratory infections such as the common cold, flu and sinusitis increase asthma attacks. Gastroesophageal reflux disease, a disorder in which the acid contents of the stomach enter the lower part of the esophagus, may cause asthma to worsen at night.