BRONCHIAL ASTHMA ntroduction Definition Etiological factors Pathophysiology Types of asthma Clinical manifestation  Restlessness Wheezing or crackles Absent or diminished lung sounds Hyper resonance Use of accessory muscles for breathing Tachypnea with hyperventilation Clinical manifestation  Diagnostic evaluation  Bronchoprovocation Testing: Testing that is done to identify inhaled allergens; mucous membranes are directly exposed to suspected allergen in increasing amounts.  Skin Testing: Done to identify specific allergens.  Exercise Challenges: Exercise is used to identify the occurrence of exercise-induced bronchospasm.  Radio allergosorbent Test: Blood test used to identify a specific allergen.  Chest Radiograph: May show hyper expansion of the airways. Managemnet Goal- Promote bronchodilationn Reduce inflammation Remove secretions Prevent ongoing symptoms Prevent asthma attack Maintain normal lung function Avoid triggers Pharmacological therapy 1. Long term control medication- Inhaled corticosteroid Leukotriene modifiers Long acting beta agonist Methylxanthines Combine inhaler 2 Quick relief medication Short acting beta agonist Anticholinergic Oral or I/V corticosteroid 3 Bronchial thermoplasty- Form severe asthma that does not respond to medication Non- pharmacological Oxygen therapy Postural drainage & chest physiotherapy Coughing & deep breathing exercise Avoidance of allergen  relaxation technique acupuncture 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 foods, molds, and pol- lens. If the attacks are seasonal, pollens can be strongly sus- pected. Patients are instructed to avoid the causative agents whenever possible. 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 the administration of oxygen and the monitoring of pulse oximetry and arterial blood gases. Fluids are administered, because people with asthma are frequently dehydrated from diaphoresis and in- sensible fluid loss with hyperventilation. Nursing diagnosis  Impaired gas exchange r/t altered oxygen supply  Ineffective airway clearance r/t bronchospasm & obstruction from narrow lumen  Ineffective breathing pattern r/t bronchospasm  Risk for increasing attack of r espiratory distress r/t exposure to allergens

1. BRONCHIAL ASTHMA
SHYAM BHATEWARA
LECTURER
INDEX NURSING COLLEGE

2. Introduction
Asthma is a chronic lung disease that inflames & narrow
the airways. Asthma is a reversible, obstructive airway
disease in which trachea & bronchi respond in a
hyperactive in certain stimuli.

3. Definition
Chronic inflammatory disorder of the airways that causes
varying degrees of obstruction in the airways Marked by
airway inflammation and hyper responsiveness to a variety
of stimuli or triggers Causes recurrent episodes of wheezing,
breathlessness, chest tightness, and coughing associated with
airflow obstruction that may resolve spontaneously

4. Etiological factors
 Environmental Factors -
Animal
Cockroaches
Dust
Exhaust fumes
Fireplaces
Molds
Perfumes or other products with aerosol sprays
Pollen
Smoke, including cigarette or cigar smoke
Sudden weather changes

5.  Physiological Factors
Gastroesophageal reflux disease (GERD)
 Hormonal changes
 Sinusitis
 Stress
Viral upper respiratory infection
Genetic factor
Hay fever & other allergies

6. Medications
Acetylsalicylic acid (aspirin)
β-Adrenergic blockers
Nonsteroidal antiinflammatory drugs
 Occupational Exposure Factors
Metal salts
Wood and vegetable dusts
Industrial chemicals and plastics

7. Pathophysiology
 Due to etiological factors
Reversible and diffuse airway inflammation
Hyper responsiveness of airway Airflow limitation
Swelling of membrane line of airway Wheezing
Cough
Contraction bronchial muscle Dyspnea
Chest tightness
Bronchial enlargement & production of thick cough
asthma

8. Types of asthma
 Allergic asthma – induced by hyper-immune response to
allergens
 Non allergic asthma (intrinsic asthma)
 Mixed asthma- both allergic & non allergic
 Cough variant asthma- absence of classical symptoms, Only
dry cough is present
 Exercise induced asthma
 Nocturnal asthma
 Occupational asthma

9. Clinical manifestation
 Restlessness
 Wheezing or crackles
 Absent or diminished lung sounds
 Hyper resonance
 Use of accessory muscles for breathing
 Tachypnea with hyperventilation

10. Clinical manifestation
Prolonged exhalation
Tachycardia
Pulsus paradoxus
Diaphoresis
Cyanosis
Decreased oxygen saturation

11. Diagnostic evaluation
 Detailed history collection
 Pulse oximetry
 Pulmonary Function Tests: Spirometry testing assesses the
presence and degree of disease and can determine the
response to treatment.
 Peak Expiratory Flow Rate Measurement: Measures maxi-
mum flow of air that can be forcefully exhaled in 1 second;
child uses a peak expiratory flowmeter to determine a “per-
sonal best” value that can be used for comparison at other
times, such as during and after an asthma attack.

12. Diagnostic evaluation
 Bronchoprovocation Testing: Testing that is done to identify
inhaled allergens; mucous membranes are directly exposed to
suspected allergen in increasing amounts.
 Skin Testing: Done to identify specific allergens.
 Exercise Challenges: Exercise is used to identify the occurrence
of exercise-induced bronchospasm.
 Radio allergosorbent Test: Blood test used to identify a specific
allergen.
 Chest Radiograph: May show hyper expansion of the airways.

13. Managemnet
Goal-
Promote bronchodilationn
Reduce inflammation
Remove secretions
Prevent ongoing symptoms
Prevent asthma attack
Maintain normal lung function
Avoid triggers

14. Pharmacological therapy
1. Long term control medication-
 Inhaled corticosteroid
 Leukotriene modifiers
 Long acting beta agonist
 Methylxanthines
 Combine inhaler

15. 2 Quick relief medication
 Short acting beta agonist
 Anticholinergic
 Oral or I/V corticosteroid
3 Bronchial thermoplasty-
Form severe asthma that does not respond to
medication

17. Non- pharmacological
Oxygen therapy
Postural drainage & chest physiotherapy
Coughing & deep breathing exercise
Avoidance of allergen
 relaxation technique
acupuncture

18. 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 foods,
molds, and pol- lens. If the attacks are seasonal, pollens can
be strongly sus- pected. Patients are instructed to avoid the
causative agents whenever possible.

19. 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 the
administration of oxygen and the monitoring of pulse
oximetry and arterial blood gases.
Fluids are administered, because people with asthma are
frequently dehydrated from diaphoresis and in- sensible fluid
loss with hyperventilation.

20. Nursing diagnosis
 Impaired gas exchange r/t altered oxygen supply
 Ineffective airway clearance r/t bronchospasm & obstruction from
narrow lumen
 Ineffective breathing pattern r/t bronchospasm
 Risk for increasing attack of respiratory distress r/t exposure to
allergens