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1. ASTHMA
This topic is from 8th question of NCLEX preparation (posted earlier).
Is a chronic inflammatory disease of airways that causes:
- hyper-responsiveness
- mucosal edema
- mucus production; which leads to, recurrent episodes of asthma
symptoms i.e.,
- cough
- chest tightness
- wheezing
- dyspnea
Strongest predisposing factor - ALLERGY

2. • It involves inflammatory and structural cells:-
(a) Mast cells - when activated, release chemicals i.e. called
MEDIATORS.
(b) Macrophages
(c) T - lymphocytes
(d) Neutrophils
(e) Eosinophils
Perpetuate inflammatory response.
1) Histamine
2) Leukotrienes
3) Bradykinine
4) Prostanoids
5) Cytokines
• Increased blood flow
• Vasoconstriction
• Fluid leak from vasculature
• Accumulation of WBC's to the area
• Mucus secretion
• Brocncho constriction
• Bronchoconstriction results from IgE-dependent
release of mediators from mast cells.
This directly contract the airway.

3. Cough [with/without mucus] Dyspnea Wheezing
EARLY
LATE
Diaphoresis
Tachycardia
Widened pulse pressure
Hypoxemia
Central cyanosis [late sign of
poor oxygenation]

4. 1) Mild intermittent.
• Symptoms 2/fewer times each week.
• Brief exacerbation.
• Nighttime symptoms 2/fewer times each month.
• Symptoms more than 2 times/week, but less than once
a day.
• Exacerbation affect activity.
• Night time symptoms more than twice/month.
• Daily symptoms.
• Frequent night time symptoms.
• Limited physical activity.
• Continual symptoms.
• Frequent exacerbation.
• Limited physical activity.
• Frequent night time symptoms.
2) Mild persistent.
3) Moderate persistent.
4) Severe persistent.

5. - Determine presence of:
• episodic symptoms of airflow
obstruction.
• airflow atleast partially
reversible.
- Positive family history.
- Environmental factors:
• seasonal changes
• high pollen counts
• climate changes
• air pollution
- Occupation related
chemicals, foods and
compounds.
- Co-morbid conditions that may accompany
asthma:
• GERD
• drug-induced asthma
• allergic broncho pulmonary aspergillosis
- Other allergic reactions can be:
• eczema
• rashes
• temporary edema
- DURING ACUTE EPISODES:
1) Sputum & blood tests-
increased level of eosinophils.
2) Increased serum level of IgE.
3) ABG analysis & pulse
oximetry - hypoxemia.
4) Increased PaCO2 - worsening
condition (pt. becomes
fatigues).
5) Spirometry - evaluate lung
capacity.

6. 1) Status asthmaticus
2) Respiratory failure
3) Pneumonia
4) Atelectasis
5) Hypoxemia

7. 2 general classes of asthma
Long acting medication Quick relief medication
1) Short acting beta2 adrenergic agonists:
- Albuterol
- Levalbuterol
- Pirbuterol
2) Anticholinergics:
- Inhibits muscarinic cholinergic receptors.
- Reduce intrinsic vagal tone of the airway.
- Ipratopium
1) Corticosteroids:
- most potent.
- anti-inflammatory medication.
- Functions:-
a) reduce symptoms.
b) improve airway functions.
c) reduce peak flow variability.
2) Cromolyn sodium and
nedocromil:
- mild to moderate anti-
inflammatory.
- alternative med. to treament.
- Functions:-
a) stabilize mast cells.
b) effective on prophylactic basis.
- CONTRAINDICATED in Acute
Asthma Exacerbations.

8. 3) Long acting beta2 adrenergic agonists:
- used with anti-inflammatory med. to control asthma symptoms.
- Functions:-
a) prevent exercise induced asthma [not recommended for immediate
relief of symptoms.]
4) Theophylline:
- mild to moderate bronchodilator.
used in addition to inhaled corticosteroids.
5) Salmeterol & formoterol:
- used in other med. in long term control of asthma.
- bronchodilate for atleast 24 hours.
6) Anti-leukotrienes:
- Inhibitors
- Montelukast
- Zafirlukast
- Zileuton
7) Immuno modulators:
- Functions:-
a) prevent binding of IgE to the high
affinity receptors of basophils and mast
cells.
b) Omalizumab- monoclonal antibody.

9. - Peak flow meters measure the highest
airflow during a forced expiration.
- The patient is indtructed in proper
techniques.
- Peak flow are monitored for 2-3 weeks
after receipt of optimal asthma therapy.
The patient's 'personal best' value is
measured.
- Zones that are determined:
1) Green : 80% - 100%
2) Yellow: 60% - 80%
3) Red: less than 60%

10. Thank you!