Evidence-based practice! Self-management education is an integral component of effective asthma care and is essential to minimize the effects for those with work-related asthma. Dodd and Mazurek (2020) looked at the number of people with a diagnosis of work-related asthma who received this very important education. The researchers analyzed data from 2012 to 2014 of the Behavioral Risk Factor Surveillance System Asthma Call-back Survey for ever-employed adults, 18 years and older, with a current diagnosis of asthma from 31 states and the District of Columbia. They found that adults with work- related asthma were more than twice as likely than those with asthma unrelated to the workplace to have ever taken a course to manage their asthma. Nearly twice as many persons with work-related asthma had an asthma action plan, compared to those with asthma not related with the workplace. Significantly more persons with work-related asthma had been shown how to use an inhaler, taught how to recognize early symptoms of an asthma episode, taught what to do during an asthma episode, taught how to use a peak flow meter to adjust daily medications, and advised to avoid asthma triggers (Dodd & Mazurek, 2020). Exercise-induced bronchoconstriction It is important to emphasize that exercise does not cause asthma but may trigger bronchoconstriction in persons with asthma. The severity of the bronchoconstriction is related to the underlying degree of AHR and the presence of airway inflammation, measured by the number of airway eosinophils. Therefore, exercise-induced bronchoconstriction (EIB) is less likely to be seen in persons with mild asthma, even with strenuous activity. Up to 90% of persons with symptomatic asthma have some degree of EIB (Mayo Clinic, 2020; O’Byrne, 2020). Changes in airway physiology triggered by large volumes of inhaled cool, dry air have been attributed to EIB. Bronchodilation initially occurs during the first 6 to 8 min of exercise, followed by bronchoconstriction, which begins within 3 min after the start of exercise and peaks within 10 to 15 min. Symptoms include shortness of breath, chest tightness, and cough. This bronchoconstriction is followed by a refractory period, related to prostaglandin release, which reduces EIB with repeated exertion. This refractory period lasts less than 4 hr. EIB also may be caused by exposure to inhalant allergens in sensitized individuals, especially during pollen or mold season (O’Byrne, 2020). Certain sports are more likely to provoke EIB. Sports with periods of exercise lasting longer than 5 to 8 min, in cold or dry air, or in chlorinated pools, place the person with EIB at high risk. These include long-distance running, cycling, cross country or downhill skiing, ice hockey, ice skating, high altitude sports, swimming, water polo, and triathlons. Medium risk sports Nocturnal asthma Nocturnal asthma is the worsening of asthma symptoms at night and may be a sign of severe or poorly controlled asthma. Symptoms include worsening coughing, wheezing, chest tightness, and difficulty breathing, and can be seen with any phenotype of asthma. Children might also experience nighttime awakening, sleep-disordered breathing, sleepwalking, difficulty falling asleep or remaining asleep, daytime sleepiness, difficulty concentrating, or behavioral issues (Duggal, 2020; Newsome, 2021). Nocturnal asthma is common, and approximately 30% to 70% of patients with asthma report nocturnal asthma symptoms at least once a month (Martin, 2021). The frequency and severity of the symptoms parallel those experienced during the day. Nocturnal awakening once or twice a month correlates with daytime symptoms occurring 2 or fewer days per week and normal spirometry; nocturnal awakening one to three times a week correlates with daytime symptoms occurring more than 2 days per week and mild airflow limitation; and nocturnal awakening four or more times per week correlates with daily daytime asthma symptoms and a decrease of 60% in peak flow or FEV1 (Martin, 2021). The mechanisms behind asthma symptoms worsening at night are not fully understood but may be related to normal hormonal changes in the evening (Martin, 2021; Newsom, 2021). Many
include soccer, rugby, football, basketball, volleyball, baseball, cricket, and field hockey, where athletes rarely perform more than 5 to 8 min of continuous exercise. Low-risk sports include non-long-distance track events inducing sprints, tennis, fencing, gymnastics, boxing, golf, weightlifting, bodybuilding, and martial arts (Gerow & Bruner, 2021). Diagnosis of EIB is made with an exercise challenge test. The person being tested walks on a treadmill for 6 to 10 min to raise the heart rate to 80% to 90% of predicted maximum. Following the exercise portion, several repeat spirometry measurements are taken to determine if there is a decrease in lung function postexercise. A positive test shows a 10% or more decrease in forced expiratory volume in 1 s (FEV1). Most clinicians consider a 15% decrease as diagnostic (O’Byrne, 2020). Treatment for EIB includes daily use of an inhaled corticosteroid and short-acting beta agonist as needed and before exercise as a preventive measure. An inhaled corticosteroid-formoterol combination as needed and before exercise is also an option. Warm-up exercise is also recommended (GINA, 2021). Leukotriene receptor antagonists may be used to address the inflammatory mediator release involved with EIB. Their usage may take 2 to 4 weeks for maximal effect. An antihistamine may be beneficial in patients with underlying allergies (Gerow & Bruner, 2021). hormones, including epinephrine, cortisol, and melatonin, have circadian patterns, which are 24-hr cycles connected to the body’s internal clock. Changes in these hormones that occur in the evening may contribute to airway inflammation, increasing the risk of nocturnal asthma symptoms. Obesity may increase the risk for nocturnal asthma, possibly related to excess fat around the throat and the increased systemic inflammation associated with obesity. Gastroesophageal reflux disease (GERD) has also been associated with nocturnal asthma, with some studies finding that nearly 80% of people with asthma may experience gastroesophageal symptoms (Newsom, 2021). Smoking and exposure to secondhand tobacco smoke can weaken lung function and irritate the airways (Vorvick, 2021). Allergens in the bedroom, including dust mites, cockroaches, rodents, animal dander, mold, and pollen can also contribute to nocturnal asthma. Additionally, exposure to these allergens during the day may result in a delayed allergic response during the night. Specific foods and medications, if taken close to bedtime, may trigger nocturnal asthma. These include sulfites, cold medicines, and aspirin (Newsom, 2021). Inhaling a greater level of cold air from an air conditioner or outside source has also been implicated in nocturnal asthma (Duggal, 2020).
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Book Code: ANCCUS2423
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