Basic Science

Basic scientific research is leading the way in establishing new ways to modify disease processes, improve survival and improve quality of life. Intensive efforts are underway by researchers to better comprehend the genetics of many diseases in respiratory and pulmonary vascular disease.

Speciality Clinical Services

Asthma

Definition:

"Asthma is a chronic inflammatory disorder of the airways. Chronically inflamed airways are hyperresponsive; they become obstructed and airflow is limited (by bronchoconstriction, mucus plugs, and increased inflammation) when airways are exposed to various risk factors". (Global Initiative For Asthma 2006)

Statistics:

Ireland has the fourth highest prevalence of asthma in the world - 470,000 people.

80-100 asthma related deaths a year.

6,300 people have severe persistent asthma.

Asthma Society of Ireland (2009)

Asthma Symptoms:

  • Wheezing
  • Chest tightness
  • Shortness of breath
  • Cough, particularly at night or early morning.

Asthma symptoms can vary from day to day and from season to season.

Risk Factors:

Exposure to;

  • Allergens such as house dust mites, pets, cockroaches, pollens and moulds
  • Occupational irritants
  • Tobacco smoke
  • Viral infections
  • Exercise
  • Emotional changes
  • Hormonal changes such as pregnancy, pre menstrual or menopause
  • Weather changes
  • Chemical irritants
  • medications such as aspirin or beta blockers.

Diagnosing asthma:

  • Complete respiratory assessment and exploration of trigger factors.
  • Pulmonary function tests with reversibility testing.
  • Peak flow recordings and diary.
  • Steroid trial.
  • Methecholine challenge
  • Skin allergy testing-
  • IgE and RAST testing

Management of Asthma

Current asthma management guidelines are available from www.ginasthma.ie

These guidelines recommend a stepwise approach to achieving optimum asthma control.


Pharmacological management:

The main goal of asthma management is to control symptoms and prevent exacerbations using the lowest amount of medication to achieve control.

Examples of Asthma Medications:

  • Reliever Inhalers- e.g. salbutamol, atrovent, bricanyl
  • Preventer Inhalers – e.g. Beclomethasone, Fluticasone, Budesonide
  • Combination Inhalers- e.g Seretide, Symbicort
  • Anti-leuketriene receptors- e.g. Singulair
  • Theophyllines- e.g Uniphylline, Aminophylline
  • Corticosteroids tablets- Prednisolone

Above are just examples of some of the medications used to treat asthma.

Assessment of inhaler technique is essential to ensure optimum amount of medicine is delivered to the lungs. There are many different types of inhaler devices to chose from which can be dependent on the individual’s best technique and preference.

For full details on asthma medication, action of drugs and possible side effects please log on to www.asthmasociety.ie or www.medecines.ie


Anti IgE Therapy

Xolair is a monoclonal antibody. This therapy is used to treat severe persistent allergic asthma. It should only be considered for patients with convincing Ig E mediated asthma with a positive skin test result. Patient’s may be considered for this treatment following specialist review, in patient’s with severe asthma, who are not controlled despite optimum treatment, and who meet the above criteria.

The Role of the Respiratory CNS in the care of Asthma Patients

  • Patient education regarding disease pathophysiology and treatment rationale.
  • Helping the patient to identify their specific trigger factors and education regarding management of trigger avoidance measures.
  • Assessment of inhaler technique and making recommendations for and education in the use of new inhaler devices.
  • Education on Peak Flow measurement and in keeping a peak flow diary.
  • All patient education is carried out on a one to one basis and is tailored to suit individual patient needs.
  • Action plans for self-management of the patient’s asthma are drawn up with the patient, the Respiratory Nurse Specialist and the Doctor.
  • The Respiratory Nurses are responsible for the administration of the sub-cutaneous injection Xolair at a Nurse-Led Xolair Clinic. For observing patients immediately following injection and reporting back to the prescribing physician.
  • Health Promotion
  • Providing Smoking Cessation support and advice to all Respiratory patients.
  • The Respiratory Nurses run a weekly Nurse-Led clinic for asthma patients to provide education and assessment of patients needs to assess if patients are reaching optimal control in their asthma management.
  • Explore issues of compliance & adherence to asthma medication and offer recommendations to improve these issues if necessary.

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