impairment and risk to determine the best interventions. Asthma severity classification is determined by the number of days/ nights with asthma symptoms, frequency of short-acting beta agonist use, activity limitations because of asthma, pulmonary function tests, and frequency of exacerbations requiring oral steroids. It should be noted that the levels of classification differ slightly between the EPR3 and GINA. The EPR3 (NHLBI, 2007) identifies four categories of severity: intermittent, mild persistent, moderate persistent, and severe persistent. GINA (2021) has incorporated intermittent asthma into the mild persistent category. Intermittent asthma historically was not treated with inhaled corticosteroids; however, the use of inhaled corticosteroids has been shown to reduce the severity of asthma exacerbations in those with intermittent asthma. GINA is currently reviewing its definition of mild asthma (GINA, 2021). For both guidelines, severity is classified by the category in which the most severe feature occurs. A step down should be considered for asthma that has been well controlled for at least 3 months. If a step up is needed because of poor asthma control, the health professional should first assess medication adherence, inhaler technique, environmental control, and comorbid conditions. Asthma management education Education for asthma self-management, and the skills needed to perform the needed management, is a critical component of asthma intervention. This should be done through a partnership between the healthcare provider and the person with asthma, with goals for treatment mutually agreed upon. The person with asthma needs clear training on using medication administration devices correctly. Adherence with medications and follow-up appointments needs to be encouraged through an agreed-upon strategy. Information about asthma needs to be provided so the person with asthma has an understanding and appreciation of what is happening to their body. The healthcare provider also needs to provide information on guided self-management, including self-monitoring of symptoms and/or peak flow measurements. A written asthma action plan that provides information on recognizing and responding to worsening asthma should be developed for each person with asthma and reviewed
as the level of asthma control or severity changes (GINA, 2021; NHLBI, 2007). The healthcare professional needs to evaluate the readiness of the person with asthma to undertake the necessary self-management interventions and should also assess for any barriers that may preclude this from happening. If barriers are present, the healthcare professional needs to work with the person with asthma to assist in eliminating these barriers. Self-Assessment Quiz Question #1 Which of the following is accurate regarding the asthma management guidelines discussed in this course? a. Both the Expert Panel Report 3 and the Global Initiative for Asthma are updated yearly. b. The Global Initiative for Asthma classifies asthma severity in three categories, whereas the Expert Panel Report 3 uses four categories. c. In terms of the goal for asthma treatment, GINA focuses on asthma risk, whereas the EPR3 focuses on asthma control. d. The age group delineation for asthma treatment is the same for both GINA and the EPR3. Self-Assessment Quiz Question #2 A patient who experienced shortness of breath was previously prescribed a rescue inhaler. At the time of the visit, the patient is not experiencing any symptoms but is concerned about having asthma. Which of the following statements is true? a. The healthcare provider should prescribe spirometry testing for a definitive diagnosis of asthma. b. An asthma diagnosis should be based on the patient’s symptoms that are specific to having asthma. c. Treating symptoms before testing increases the ability to achieve an accurate diagnosis. d. Spirometry testing may be normal if the patient is not experiencing any asthma symptoms.
TYPES OF ASTHMA IN ADULTS
Work-related asthma Work-related asthma is caused by an occupational environment, characterized by variable airflow limitation and/or AHR attributable to stimuli encountered in the workplace (Quirce & Sastre, 2020). An estimated 11 million workers are exposed to at least one of the numerous agents known to be associated with occupational asthma. Approximately 17% of all adult- onset asthma cases are related to the work environment. Persons with work-related asthma are more likely to experience asthma attacks, emergency room visits, and worsening asthma symptoms than other adults with asthma. Workers who are African American, American Indian/Alaska Native, multiracial, or of Puerto Rican ethnicity have a higher prevalence of work- related asthma. No gender differences have been noted (National Institute for Occupational Safety and Health [NIOSH], 2017; Occupational Safety & Health Administration, n.d.). Workers at greatest risk for occupational asthma include bakers, detergent manufacturers, drug manufacturers, farmers, grain elevator workers, laboratory workers (especially those working with laboratory animals), metal workers, millers, plastics workers, and woodworkers (MedlinePlus, 2021). The pathophysiology of work-related asthma is the same as that for non-work-related asthma: inflammation, edema, bronchoconstriction, and buildup of mucus in the airways lead to coughing, wheezing, chest tightness, and shortness of breath. Triggers include environmental sensitizers, irritants, or physical conditions. Sensitizers initiate an allergic response. Typically, there is a latency period of at least a few months between initial exposure and the development of symptoms. Sensitizers are categorized as either high or low molecular weight. Irritants in the workplace create a nonallergic response. Physical conditions, such as exposure to cold air and physical exertion, may lead to bronchoconstriction (NIOSH, 2017; Quirce & Sastre, 2020).
The diagnosis of work-related asthma includes an exposure history. Work-related asthma should be considered in individuals with new-onset asthma or worsening asthma after previously being controlled. Known exposures from all workplaces, past and present, should be assessed. Symptoms may develop at work or may be delayed, occurring after leaving the workplace (NIOSH, 2017; Quirce & Sastre, 2020). The key to managing occupational asthma is to remove the worker from exposure as quickly as possible after the onset of symptoms. In some cases, occupational asthma may resolve if removal from exposure occurs soon after onset of symptoms. The use of respiratory protective equipment decreases worker exposure levels and reduces the incidence of occupational asthma, but does not completely protect against development of work-related asthma. Exposure monitoring, combined with medical surveillance of exposed workers, enables early identification of sensitization and removal from exposure to these agents for those who develop occupational asthma. Unfortunately, very low concentrations of antigen may be undetectable but still provoke bronchospasm in sensitized workers. Smoking cessation should be advised, as this may decrease the risk of antigenic sensitization in the workplace (Lemiere & Bernstein, 2019).
Book Code: ANCCUS2423
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