Asthma: A Review & Clinical Practice

Asthma is a chronic lung disease that can be easily bypassed when assessing and treating a patient. In fact, according to the National Institute of Health, asthma affects more than 25,000,000 Americans. Many of which have experienced the onset of this disease since childhood. Therefore, this chronic disease could easily go under the radar because he/she has had to deal with this disease the majority of his/her life. “Why else would my neck or shoulder pain originate from the asthma I’ve experienced my whole life?” Reviewing a patient’s history and background information provides a full picture and asthma may be just one piece to the puzzle.

Review on Asthma

Types1:

Allergic – Induced by environmental allergies. Family history of allergies.

Non Allergic – Induced by irritants in air such as smoke.

Occupational – Induced by exposure to substance in workplace.

Exercise Induced – Induced by aerobic type activity.

Nocturnal – Induced at night – allergic or nonallergic.

Common Co-morbidities Associated with Asthma1:

Obesity, Gastroesophageal reflux disease (GERD), Sinusitis, Rhinitis, Obstructive sleep apnea, Anxiety, Depression, Hormonal disturbances, and Chronic Obstructive Pulmonary Disorder (COPD).

Symptoms and Level of Severity1:

Mild Intermittent – Symptoms occur less than 2x a week and exacerbations, attacks, or night time symptoms occur less than 2x a month.

Mild Persistent – Symptoms are more severe and occur greater than 2x a week  but less than 1x a day. Night time symptoms occur less than 2x a month.

Moderate Persistent – Symptoms occur daily and attacks may last for several days. Night time symptoms occur greater than 2x a week. Daily medication is needed for management.

Severe Persistent – Continual symptoms day and night. Activity is limited and exacerbations are frequent.

Test and Measures1:

Dyspnea – Borg Rating of Perceived Exertion or Visual Analog Scale

Symptoms – Asthma Control Test (ACT) or Juniper Asthma Control Questionnaire (ACQ)

Altered breathing pattern – Observation of breathing pattern

Abnormal breath sounds – Lung auscultation

Airflow limitation – Peak expiratory flow (PEF)

Postural changes – Observation of posture in sitting and standing

Weakness – Standard manual muscle testing, Sit-to-Stand Test, or Timed Chair Rise
Cardiovascular deconditioning – 6-Minute Walk Test (6MWT) or Cycle ergometer test

Altered body composition – Body mass index (BMI) or Skinfold thickness test

Balance – Timed “Up and Go” Test or Berg Balance Scale

Mobility – Dynamic Gait Index

Self-care – Activities of daily living scales

Health status – St. George’s Respiratory Questionnaire (SGRQ) or Asthma Impact Survey

Quality of life – Asthma Quality of Life Questionnaire (AQLS)

Intervention Recommendations1:

Aerobic training – Low-to-moderate intensity with aerobic exercise recommended. According to the American College of Sports Medicine: Rhythmic exercise for large muscle groups 3 to 5 days a week at 50% of maximal exertion. According to the American Thoracic Society: Exercise at 60%-75% of maximal work rate for 20-30 min/day, 2 to 5 days a week.
Breathing training – Nasal breathing, breath holding, and relaxation exercises help decrease use of medications and improve quality of life.

Prevention – Special considerations for exercise-induced asthma (EIA), including physical warm-up prior to intense exercise for bronchospasm prevention, 6-10 min light activity or stretching, proper hydration, masks to ensure humidity for next inspiration

Once again it is important to consider any relevant information when assessing a patient’s full history. Asthma, the chronic lung disease, can cause significant restrictions within the thoracic/cervical region, rib cage, shoulder region, etc. Any lung disease or restrictions associated with the chest cavity are important when treating the root cause of a patient’s pain.

Resource: PT Now – APTA (Member Access)

1.) American Physical Therapy Association. Asthma. (2015). Retrieved September 18, 2015, from http://www.ptnow.org/clinicalsummaries/quickdetail.aspx?cid=edf5f6b3-e2f1-4409-9f46-a4b96d4f4e25

Bradley Murrison, PT, MPT