This document defines bronchial asthma as a chronic inflammatory disease of the small airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, cough and hyperresponsiveness to various stimuli. The causes include sensitivity to allergens like pollen, dust and infections. There are two main types - extrinsic (atopic, early onset) and intrinsic (late onset). Status asthmaticus is an acute severe episode lasting more than 24 hours not relieved by usual treatment and can lead to respiratory failure. Treatment involves rapid bronchodilation, avoiding triggers, inhaled corticosteroids and other drugs, and managing exacerbations with oxygen, nebulizers and systemic corticosteroids.

1. BRONCHIAL ASTHMA
Definition
It is an inflammatory disease of small air ways
characterized by recurrent episodes of
wheezing , breathlessness, chest tightness,
cough and is generally associated with a hyper
responsiveness to a variety of stimuli.
causes:
1. Over pollen etc
2. Due sensitiveness to foreign proteins like
dust, to infection in the bronchial tree.

2. TYPES
1. EXTRINSIC ASTHMA.(ATOPIC / EARLY
ONSET)
2. INTRINSIC ASTHMA (LATE ONSET)
PRECIPITATING FACTORS
Cold air, tobacco smoke , dust, fumes,
emotional stress, resp infections, intake of
drugs,--NSAIDS, beta blockers, chemicals -
Na, K, bisulfate, Sulphurdioxide, Allergens -
ingested fish, nuts, strawberries, -inhaled
dust, pollen, mites -food additives –tartrazine,
aginomotto occupation- dust of grain, wood.
etc

3. PATHOPHYSIOLOGY
• Autonomic nerves are stimulated by irritants
which increases the mucous secretions and
capillary dilatations
• Antigen antibody reaction –IgE antibodies.

4. Signs and symptoms
Early symptoms
• Dry cough and mild chest tightness
Progressive symptoms
• Wheezing, coughing, shortness of breath
• Prolonged expiration and laboured
inspiration , dyspnoea, weak pulse,
sweating, productive cough, restlessness,
anxiety, apprehension, use of accessory
muscles , hypercapnoea, resp acidosis,
hypoxia.

5. MANAGEMENT
AIMS OF MANAGEMENT
1.To improve the air way function rapidly
2. To avoid hypoxia
3. To prevent respiratory failure and death
Objectives of treatment
• Treatment of infections
• Avoidance of allergens
• Avoid precipitating factors
• Use of drugs
• Hypo sensitization

6. Nursing management
• Establish airway clearance and breathing
• Provide fowler’s position with extra pillows
• Administer humidified O2 @ 6- 8 L / mts during
ac attacks
• Administer prescribed drugs- S/C , nebulization
• Regulate temp, humidity to comfortable levels
• Increased intake of warm fluids, to dilute
bronchial secretions. IV infusion if required.
• Chest physiotherapy
• Reassurance
• Avoid resp infections and secondary attacks

7. Commonly used drugs
ADRENERGIC STIMULANTS
• Adrenalin - It stimulates alpha and beta
adrenergic receptors of autonomic
nervous system .
1. Alpha adrenergic action –
vasoconstriction
2. Beta adrenergic action – bronchodilation
It is the drug of choice as it is a potent
bronchodilator and its rapid action
Dose .3 to .5 ml s/c

8. • Inhalation of drugs
• 1. Nebulization with salbutamol or
terbutaline ( dose- 2.5 – 5 mg in 3-4 ml of
saline every 15- 20 mts for 3 doses )
• Continuous nebulization of salbutamol in a
dose of 10-15 mg over a period of 2 hrs is
an alternative method.
• Metered dose inhalers –
• Initial dose for MDI is 4- 8 puffs every 15-
20 mts

9. • Isoproterenol –Relaxes the smooth muscle
of bronchial wall.
• Terbutalin –short acting bronchodilators
for 4 - 6 hrs.
METHYL XANTHINES
• Deriphyllin – relaxes bronchial smooth
muscles. DOSE –I V a loading dose of 6
mg / kg followed by an infusion of
1mg/kg/hr for 12 hrs and 0.8 mg /kg/hr
thereafter.

10. Anti inflammatory drugs
• Beclomethsone dipropionate – (200 micro
gm) twice daily by MDI
• Budesonide (200 micro gm) twice daily by
MDI.
• Oral prednisolone
• Methyl prednisolone – IV 125 mg stat
,followed by 40 – 60 mg IV 6th hrly .

11. Drugs used for prevention
• Sodium cromoglycate -- this acts by
preventing mediator( broncho constrictors)
release from mast cells.
• Nedocromil sodium – it is an anti
inflammatory drug with similar properties
of those of sodium cromoglycate. MDI
dose 4mg 2 – 4 times a day.

12. STATUS ASTHMATICUS
• It is an acute severe life threatening
episodes of Bronchospasm that lasts for
more than 24 hrs. The critical distressing
condition is not relieved by conventional
bronchodilator therapy and leads to
respiratory insufficiency and hypoxia .
Attacks may lasts for many days with out
relief and terminate in death.

13. PATHOPHYSIOLOGY
• Constriction of bronchioles
• Swelling of bronchial mucosa
• Thickened secretions leading to blockage
of bronchioles
• Abnormal ventilation perfusion
• Respiratory acidosis and alkalosis.

14. Signs and symptoms
• Laboured breathing
• Enlargement of neck veins
• Exhalation with wheeze
• Hypoxia
• CO2 retention leading to muscle twitching
,flapping tremor and diaphoresis.
• Tachycardia and high BP
• Low SPO2,pulmonary vasoconstriction
• Heart failure and death due to suffocation

15. Treatment and nursing care
• Careful monitoring of patient
• ABG analysis
• High concentration of O2 therapy
• High dose of beta agonist by nebulization
• Systemic corticosteroid
• Assisted ventilation- when medical therapy
fails.
• Adequate hydration –IV infusion