Uncontrolled asthma PDF Flashcards
asthma key concepts
obtructive pulmonary disease with an inflammatory component
balance between symp and para is distorted
OMT can improve severity and decrease need for pharm
most common chronic disease of children and adolescents
asthma.
most common symptoms- wheezing, SOB, chest tightness, cough.
exacerbated by cold, exercise, infection, meds such as aspirin, allergens.
things that can precipitate an attack
stress, exercise, GERD, allergens, irritants, meds, poor diet and mucogenic foods, viral respiratory infections, esp. sinusitis, weather changes.
injuries that may precipitate an attack
head or sacral regions
2 components of asthma
bronchospasm and inflammation
vasovagal stimulation of bronchus
bronchoconstriction
may be the mechanism involved in association betw GER and asthma
classifications of asthma
mild intermittent- treat as needed
mild persistent- more than twice weekly but not daily. daily inhailed corticosteroid (more than 2 d/wk, less than once daily)
moderate-persistent: daily and 1 night per week (under 5 years - low dose inhaled corticosteroid + LABA; over 5 years low/med + LABA)
severe-persistent asthma- continuous or repeatedly during day and frequent at night. high dose inhaled + lABA; oral corticosteroid PRN.
Biomechanical model and asthma
thoracic cage is the center of activity (accessory muscle involvement)
factors that affect breathing difficulties (from an OMT perspective)
upper thoracic vertbrae, ribs, sternum
T1-6 (symp innervation to the lungs)
OA jxn and course of the vagus nerve
accessory muscles of respiration
anterior cervical fascia
thoracic diaphragm (the diaphragm is enervated by the phrenic nerve from the cervical plexus C3-5, and its mobility is influenced by the lower six ribs, L1-2 and the sternum)
Chapman’s reflexes for the lungs, sinuses, and adrenal glands
the cranial sacral mechanism
T10-L2 and the lower ribs
infants are at risk for muscle fatigue and respiratory failure due to
immaturity of acetylcholinesterase
and increased contraction and relaxation times of muscles
also evidence that the immature innervation patterns in respiratory muscles of kids more than 3 years old result in uncoordinated and random contraction sequences that become exacerbated during times of increased demand.
compared with adults, the mechanical effectiveness of the diaphragm and rib cage
is compromised in children less than 10 years old.
The rib cage is more flexible and laterally splayed, and the dome of the diaphragm is flatter than in an adult.
–> diaphragm excursion is shallower, intrathoracic respiratory pressures are less negative, and there is less tissue recoil during exhalation.
in time of increased demand, kids will compensate by increasing the rate and decreasing the depth of respiration.
Respiratory-circulatory model and asthma
movement of the diaphragm not only changes the intrathoracic and intra-abdominal pressures but also alters the circulation and lymphatic flow in these respective cavities
to some extent, the removal of cellular waste products, the maintenance of tissue pH, and the reentry of fluids into the circulatory cycle are influenced by diaphragmatic function.
Neurologic model and asthma
symp fibers arise from chain ganglion at level T1-6
parasymp- vagus
treat upper thoracic area and cervical region- incl. craniocervical jxn and cranial base (good for adults w/ asthma and hay fever, too)
behavioral model and asthma
emotional riggers
poor outcomes in asthmatic individuals with inadequate support systems and insufficient self-care
self-management education and family therapy useful
metabolic energy and asthma
frewh, whole food diet
food colorings, sulfites, preservatives and other modifiers can cause asthma and allergic rxns.
some should avoid milk, ice cream, cheese, processed flour, sugar, and corn syrup sweeteners.
some have antioxidant imbalancess- adequate vitamin C with bioflavonoid and B vitamins may be beneficial
IV magnesium - good effect on hospital stays
