The process of diagnosing nocturnal asthma is the same as that for diagnosing asthma in general. A diagnosis of asthma needs to be confirmed. For persons with an asthma diagnosis, typical asthma symptoms occurring during the night or early morning are usually because of asthma. With the new onset of nocturnal symptoms, office spirometry is usually done to assess daytime asthma control and to guide the selection of controller medication(s) for therapy. If nocturnal symptoms respond to this treatment, no further testing is needed. For a person without an asthma diagnosis, either asthma needs to be confirmed by spirometry or bronchoprovocation testing, or alternative diagnoses need to be evaluated (Martin, 2021). Management goals for nocturnal asthma are essentially the same as the goals for asthma in general: reduction of symptoms, improvement in lung function, and reduction in risk for an exacerbation. As stated previously, therapy is generally based on the severity and frequency of symptoms. Specific interventions include medication regimen and controlling contributing factors related to allergen exposure, rhinitis and sinusitis, gastroesophageal reflux, and sleep apnea (Martin, 2021). Evidence-based practice! Tinschert and colleagues (2020) examined the relationship of nocturnal cough and sleep quality with the level of asthma control in the person with asthma. The researchers investigated whether smartphone-recorded nocturnal cough and sleep quality could be used for detection of uncontrolled asthma or meaningful changes in asthma control, as well as the prediction of asthma exacerbations. Data from 79 adults with asthma was collected for 29 days through smartphones for sleep quality and nocturnal cough frequencies. Results showed that nocturnal cough and sleep quality were significantly associated with lack of asthma control. Sleep quality was more useful for detecting weeks with uncontrolled asthma, while nocturnal cough better detected weeks with asthma control deteriorations. Both predicted asthma attacks up to 5 days ahead.
Self-Assessment Quiz Question #3 Your patient, who works in a bakery, comes for an annual checkup after returning from a 2-week vacation. Before leaving for vacation, the patient was having trouble sleeping because of difficulty breathing, which occurred nightly and persisted during the day as well. The patient had been symptom-free throughout the vacation. Which type of asthma should the healthcare provider suspect? a. Nocturnal asthma b. Exercise-induced bronchospasm Healthcare Professional Consideration: Asthma is not a one-size-fits-all disease. Healthcare providers need to play detective and ensure they are asking the right questions to elicit the information needed to devise the correct treatment plan. They cannot assume that the patient knows what the healthcare providers need to know, and an important piece of vital information might be missed. A thorough understanding of the precipitating and exacerbating factors of symptoms, when they occur, and what makes them better is essential to determine the correct phenotype and best treatment plan. c. Work-related asthma d. Intermittent asthma
ANTECEDENT CONDITIONS
Atopic march The term atopic march describes the natural progression of allergic diseases from infancy to adulthood. These diseases occur in a time-based order: from atopic dermatitis (eczema) and food allergy in infancy; to seasonal and environmental allergies including allergic rhinitis in children ages 4 to 6 years; to the development of asthma by age 7 years (Asthma and Allergy Network, n.d.). Atopic dermatitis, a recurrent skin condition characterized by chronic skin inflammation, itching, and an impaired skin barrier, is the first manifestation of the atopic march. This condition is classified as either intrinsic, with normal immunoglobulin E (IgE) levels, or extrinsic (or nonallergic), with high IgE levels associated with increased disease severity. Yang and colleagues (2020) report that those infants with extrinsic atopic dermatitis are at increased risk of developing the atopic march. Once an individual has commenced on the atopic march, it is difficult to halt the progression (Hill & Spergel, 2018). According to Stokes and Casale (2021), nearly 80% of children with atopic dermatitis will subsequently develop allergic rhinitis or asthma. Several processes underlying the atopic march have been put forth (Yang et al., 2020). An effective skin barrier has been deemed essential in preventing the progression. The skin is the foremost barrier for defense against pathogens and environmental pollutants, providing microbial, chemical, physical, and immune protections. Allergens, including food and aeroallergens, can enter the body through damaged skin to cause sensitization, which can lead to atopic dermatitis and, subsequently, allergic asthma and allergic rhinitis. The inflammatory factors that ensue may enter the digestive and respiratory tracts through blood circulation to facilitate the development of allergic asthma, allergic rhinitis, and food allergy if allergens are re-encountered. Thus, impaired skin might be a potential mechanism underlying the atopic march. Another mechanism involves the microorganisms colonized in the intestine, skin, and respiratory tract (Yang et al., 2020).
Alterations in skin and intestinal microbes were noted in infants with atopic dermatitis. Infants who had a positive skin prick test for food sensitization also had lower intestinal microbes. Infants with low diversity in intestinal flora at 1 month of age were likely to develop allergic asthma at school age. However, Yang and colleagues (2020) stress that further studies are needed to determine whether changes in these microorganisms are a cause or a consequence of the atopic march. Atopic dermatitis is a chronic inflammatory skin disorder most commonly diagnosed in the first 6 months of life, which is marked by skin barrier dysfunction, frequent skin infections, and impaired quality of life. Severity of atopic dermatitis is a factor determining subsequent development of allergic disease (Hill & Spergel, 2018; Tham & Leung, 2019). The severity of atopic dermatitis positively correlates with risk of developing food allergies. The fact that sensitization occurs before food ingestion suggests that sensitization to foods occurs via exposure through inflamed skin as opposed to the gastrointestinal tract (Hill & Spergel, 2018). Alduraywish and colleagues (2017) found that food sensitization in the first 2 years of life was associated with increased risks of asthma and allergic rhinitis by age 10 years. Infants with early-onset persistent atopic dermatitis were three times more likely to develop asthma and allergic rhinitis in later childhood compared to children with late-onset atopic dermatitis that began after 2 years of age. Preventive interventions aimed at halting the progression of the atopic march have been suggested. Many of these measures focus on reducing the risk of atopic dermatitis through prophylactic skin barrier protection with the use of standard emollients beginning very early in life in high-risk neonates (Tham & Leung, 2019). Glatz and colleagues (2018) found that the preventive effects of emollients in infants at risk for atopic dermatitis may be related to decreased skin pH and an increase in the bacteria, Staphylococcus salivarius. Decreased food sensitization at ages 6 and 12 months was found when emollient
Book Code: ANCCUS2423
EliteLearning.com/Nursing
Page 6
Powered by FlippingBook