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used for long-term prevention.

Other Drugs: Xanthines such as theophylline have been used successfully in treating chronic severe steroid-dependent asthmatics. Cromolyn sodium decreases broncho-spasm, but it is not effective for acute bronchospasms and is used as a preventive measure.

Independent

Maintenance of airway, breathing, and circulation is the primary consideration during an acute attack. Patients should be on bedrest to minimize their oxygen consumption and to decrease the work of breathing. Note that patients usually assume a position to ease breathing; some patients breathe more easily while sitting in an upright position: do not impose bedrest on a patient who can breathe only in another position. Ask questions that can be answered by nodding or a brief one-word answer so the patient can conserve energy for breathing. If the patient is a child, allow the parents to stay with the child during acute attacks. Have the parents identify a security item that reassures the child, such as a special blanket or toy, and keep the item with the child at all times. Reinforce coping strategies to the parents, and allow them to express any feelings of guilt and helplessness.

110 Atelectasis

For strategies to prevent future attacks, discuss triggers that can induce asthma attacks and ways to avoid them. If the attack is triggered by an allergen, explore with the patient or family the source and discuss possible strategies for eliminating it. Cold air and exercise may increase symptoms. Aspirin and nonsteroidal anti-inflammatory agents can cause sudden, severe airway obstruction.

Outline the signs and symptoms that require immediate attention. Instruct the patient to notify the physician should she or he develop a respiratory infection that could trigger an attack. Instruct patients regarding their medications, particularly metered-dose inhalers (MDIs), and the indications for use. It is important that the patient use the bronchodilator MDIs first, then use the steroid inhalers. Explain to patients on steroid inhalers need to rinse their mouths out after using them to avoid getting thrush.

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