1. Asthma Management Pathophysiology and Management University of Utah Center for Emergency Programs and The Utah Asthma Program

2. Asthma Pathophysiology

3. Asthma Description Asthma is defined as a chronic inflammatory disorder of the airways. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or early in the morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment.

4. Asthma Triggers Indoor Air Pollutants Outdoor Air Pollutants Other Types of Triggers

5. Indoor Air Pollutants Second Hand Smoke Combustion Products Biologicals Volatile Organic Compounds

6. Outdoor Air Pollutants Ozone (O 3 ) Particulate Matter –Nitrogen Dioxide (NO 2 ) –Sulfur Dioxide (SO 2 )

7. Other Types of Triggers Vigorous Exercise Exposure to Cold –Sudden Changes in Temperature Excitement OTC Medications –Non-Steroidal Anti-Inflammatories

8. Specific Pathophysiology With exposure to a trigger, a cascade of cellular responses result in: –Increased mucus production –Mucosal swelling –Bronchial muscle contraction

9. Pathophysiology Continued Early Acute Result is: –Hyperesponsiveness –Obstruction Late Acute Result is: –Recurrence of symptoms in 4-12 hours Chronic Result is: –Airway Remodeling

10. Asthma Signs and Symptoms

11. Classification of Asthma Mild Intermittent Asthma Mild Persistent Asthma Moderate Persistent Asthma Severe Persistent Asthma

12. Asthma as a Diagnosis

13. Special Populations Infants Children Teenagers Pregnant Women

14. Asthma Management

15. Asthma Management Plan Medications Management Goals Physician Information Individual Triggers

16. Asthma Action Plan Peak Flow Measurements Asthma Symptoms Asthma Medications Emergency Numbers

17. Asthma Medications Bronchodilators (Sympathomimetics) Bronchodilators (Anticholinergics) Inhaled Corticosteroids Biologic Response Modifiers (Monoclonal Antibodies) Leukotriene Receptor Antagonists Mast Cell Stabilizers Methylxanthene Derivatives

18. Bronchodilators (Sympathomimetics) Albuterol Salmeterol Terbutaline

19. Bronchodilators (Anticholinergics) Ipratropium

20. Inhaled Corticosteroids Beclamethasone Flunisolide Triamcinalone

21. Biologic Response Modifiers (Monoclonal Antibodies) Omalizumab

22. Leukotriene Receptor Antagonists Montelukast Zafirlukast

23. Mast Cell Stabilizers Cromolyn Nedocromil

24. Methylxanthene Derivatives Theophylline

25. Additional & Alternative Therapies Asthma Education Cognitive Behavioral Therapy –Relaxation Exercises Chinese Herbal Therapy http://nccam.nih.gov/

26. Implications for EMS Providers Recognize Asthma Triggers Recognize Asthma Symptoms Understand …