Bronchial ASTHMA
WHAT IS BRONCIAL ASTHMA?
• Is a chronic inflammatory disease of the airways that causes airway
hyperresponsiveness, mucosal edema, and mucus production.
• Asthma differs from other obstructive lung diseases in that it is largely
reversible, either spontaneously or
with treatment.
• Patients with asthma may experience
symptom-free periods alternating with acute
exacerbations that last from minutes to hours
and days. Asthma is the most common chronic
disease of childhood and can occur at any
age.
• The “Asthma Awareness, Education and Treatment Act of 2005” shares
this information: “According to the United Nations Daily Highlights,
asthma kills over 180,000 people globally ever year. In the Philippines
asthma affects over 6 million children. The Philippines is ranked 32nd in
‘self-reported asthma.’ The country has a prevalence rate of about 12
percent. A nationwide study conducted by the University of Santo
Tomas showed that about 12.4 percent of children aged 14 to 15 years
old are afflicted with asthma. Most of these children come from low-
income families or communities.”
• The 2014 Global Asthma Report said about 300 million people around
the world are affected by asthma. In the Philippines one out 10 people
is suffering from this debilitating disease.
PATHOPHYSIOLOGY
PREDISPOSING FACTORS CAUSAL FACTORS CONTRIBUTING FACTORS
• ATOPY • EXPOSURE TO INDOOR AND • RESPIRATORY INFEV TIONS
• FEMALE GENDER OUTDOOR ALLERGENS • AIR POLLUTION
• OCCUPATIONAL SENSITIZERS • ACTIVE/PASSIVE SMOKING
INFLAMMATION
HYPERRESPONSIVENESS AIRFLOW LIMITATION
SYMPTOMS
• WHEEZING
• COUGH
• DYSPNEA
• CHEST TIGHTNESS
Diagnosing Bronchial
Asthma
Asthma symptoms don't always happen during your
doctor's appointment, it's important for you to
describe your, or your child's, asthma signs and
symptoms to your health care provider. You might
also notice when the symptoms occur such as
during exercise, with a cold, or after smelling smoke.
Asthma tests may include:
Spirometry: A lung function test to measure breathing
capacity and how well you breathe. You will breathe into
a device called a spirometer.
1 2
3 4
Peak Expiratory Flow (PEF): Using a device called a peak flow
meter, you forcefully exhale into the tube to measure the force
of air you can expend out of your lungs. Peak flow monitoring
can allow you to monitor how well your asthma is doing at
home. Green zone signifies 80%-100% of personal best; yellow,
60%- 80% and red , less than 60%/.
If peak flow falls below the red zone, the patient should take the
appropriate actions prescribed by his or health care provider.
• Chest X-ray: Your doctor may do a chest X-ray to rule
out any other diseases that may be causing similar
symptoms.
CLINICAL MANIFESTATIONS
THREE MOST COMMON SYMPTOMS IN ASTHMA:
□ Cough
□ Dyspnea
□ Wheezing
• Asthma attack often occurs at night or early in the morning, possibly
because of circadian variations that influence airway receptor thresholds.
• An asthma exacerbation may begin abruptly but most frequently is
preceded by increasing symptoms over the previous days.
• There is cough, with or without mucus production.
• There may be generalized wheezing, first on expiration
and then possibly during inspiration as well.
• Generalized chest tightness and dyspnea occur.
Expiration requires effort and becomes prolonged. As
the exacerbation progresses, diaphoresis, tachycardia,
and widened pulse pressure may occur along with
hypoxemia and central cyanosis(a late sign of poor
oxygenation)
• Symptoms of exercise-induced asthma include maximal
symptoms during exercise, absence of nocturnal
symptoms, and sometimes only a description of a
“chocking” sensation during exercise.
prevention
• Patients with recurrent asthma should undergo tests
to identify the substances that precipitate the
symptoms. Possible causes are dust, dust mites,
roaches, certain types of cloth, pets, horses,
detergents, soaps, certain food, molds and pollens.
• Patients are instructed to avoid the causative agents
whenever possible. Knowledge is the key to quality
asthma care.
complications
• Complications of asthma may include status asthmaticus,
respiratory failure, pneumonia and atelectasis. Airway
obstruction particularly during acute asthmatic episodes,
often results in hypoxemia, requiring administration of
oxygen and monitoring of pulse oximetry and arterial
blood gases. Fluids are administered, because people
with asthma are frequently dehydrated from diaphoresis
and insensible fluid loss with hyperventilation.
Medical management
• There are two classes of asthma medications: quick
relief medications for immediate treatment of asthma
symptoms and exacerbations and the long acting
medications to achieve and maintain control of
persistent asthma.
• Because the under lying pathology of asthma is
inflammation, control of persistent asthma is
accomplished primarily with regular use of anti-
inflammatory medications.
Quick relief medications
Short-acting beta2-adrenergic agonists are the medications of
choice for relief of acute symptoms and prevention of exercise-
induced asthma. They have rapid onset of action. Anticholinergics
(eg, ipratropium bromide) may have an added benefit in severe
exacerbations of asthma, but they are used more frequently in
COPD.
Long-acting control medications
Corticosteroids are the most potent and effective anti-
inflammatory medications currently available. They are broadly
effective in alleviating symptoms, improving airway function, and
decreasing peak flow variability. Initially, an inhaled form used. A
spacer should be used
with inhaled corticosteroids, and the
patient should rinse his/her mouth
after administration to prevent thrush,
a common complication
associated with the use of inhaled
corticosteroid.
• Cromolyn sodium (Intal) and
nedocromil (Tilade) are mild to
moderate inflammatory agents
that are used more commonly
in children. They are also
effective on a prophylactic basis
to prevent exercise-induced
asthma or in unavoidable
exposure to known triggers.
These medications are
contraindicated in acute
asthma exacerbations.
• Long-acting beta2-adrenergic
agonists are used with anti-
inflammatory medications to control
asthma symptoms, particularly those
occurring at night. These agents are
also effective in exercise-induced
asthma. Long-acting beta2 adrenergic
agonists are not indicated for
immediate relief of symptoms.
Theophylline (Slo-bid, Theo-24, Theo-
Dur) is a mild to moderate
bronchodilator that is usually used in
addition to inhaled corticosteroids,
mainly for relief of night time asthma
symptoms.
• Leukotriene modifiers (inhibitors) or anti-leukotrienes, are
synthesized from membrane phospholipids thru a cascade
of enzymes are potent bronchoconstrictors that also dilate
blood vessels and alter permeability.
• They may provide an alternative to inhaled corticosteroids
for mild persistent asthma, or they may be added to a
regimen of inhaled corticosteroids in more severe asthma to
attain further control.
Nursing management
The immediate nursing care of patients with asthma depends on the
severity of the symptoms.
The nurse assesses the patient’s respiratory status by monitoring the
severity of the symptoms, breath sounds, peak flow,
pulse oximetry and vital signs.
The nurse generally performs the ff tasks:
• Obtains a history of allergic reactions to
medications before administering medications
• Identifies medications the patient is currently taking
• Administer medications as prescribed and monitors the
patient’s responses to those medications. An antibiotic may be
prescribed if the patient has an underlying respiratory
infection.
• Administers fluid if the patient is dehydrated.
• If the patient requires intubation because of acute respiratory
failure, the nurse assists with the
intubation procedure, continues close monitoring
of the patient, and keeps the patient and family
informed about the procedure.
