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1. Asthma
By:
Logman mohammed
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2. Asthma is a chronic inflammatory disease of the
airways characterized by
 bronchial hyper-responsiveness
 mucosal edema
 mucus production.
 Air flow obstruction, an underlying inflammation
Introduction
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3. Asthma have a reduced rate of pulmonary airflow
resulting from increased inflammation.
Airway obstruction is usually reversible in patients
with asthma
Either disease may develop acute exacerbations with
increased inflammation of the airway
Cause of asthma is unknown
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Introduction

4.  Asthma can be inherited
 Smoking during pregnancy increases the
chance of a child developing asthma
 Second-hand smoke increases the chance of
developing asthma
 Irritants in the workplace may lead to a
person developing asthma
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Introduction

5. Environmental factors, such as changes in
temperature (especially warm to cold) and
humidity
Air pollutants
Strong odors (perfume)
 Seasonal allergens
Triggers of Asthma
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6.  Stress and emotional distress
Medications (aspirin, NSAIDS, beta-blockers,
cholinergics)
Chemicals (household cleaners)
Sinusitis with postnasal drip
Viral respiratory tract infection
cont
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7. • Inflamation and asthma:
The asthmatic inflammatory has been
characterized as consisting of an immediate
response and late response
Asthmatic patient may suffer only an immediate
reaction , only a late phase reaction or dual
reaction
Pathogenesis
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8. Immediate response:
Inhalation of allergens initiate immediate response
in form of dyspnoea,cough ,chest tightness and
wheezing . This response occurs shortly after
allergens or irritants exposure within the first
15min-1 hour .
It is caused by mediators of immediate
hypersensitivity e.g mast cells are activated
leading to release of chemical mediators that
produce inflammatory reaction and symptoms
formation
Pathogenesis
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9.  Late-phase response
Occurs within 4-6 hours after initial attack
Caused by influx of inflammatory cells such as
eosinophil and neutrophils . These cells release
chemical mediators that produce inflammatory
reaction and symptoms formation
Pathogenesis
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10. 10logman

11. Extrinsic asthma:(allergic asthma)
Hypersensitivity reaction to inhalant allergen
Mediated by immunologic.
Intrinsic asthma (called non-allergic asthma)
Bronchial smooth muscles and bronchial secretions
are controlled by autonomic nervous system.
Cholinergic and alpha-adrenergic stimulation cause
broncoconstriction while the beta adrenergic
stimulation cause relaxation.
Types of asthma
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12. • It is theorized that exposure to
cod,exercise,air-polluton ,emotion and aspirin
stimulate cholinergic and alpha-adrenergic
system resulting in bronchial constriction and
increased bronchial mucus secretion.
• External allergens has no role in the
production of this type so the term of intinsic
asthma is used.
cont
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13. • Recurrent episodes of wheezing
• Breathlessness - cough
• chest tightness
• Expiration may be prolonged
• Inspiration-expiration ratio of 1:2 to 1:3 or 1:4
• Bronchospasm, edema, and mucus in bronchioles
narrow the airways
• Air takes longer to move out
Clinical Manifestations of asthma
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14. An acute attack usually reveals signs of hypoxemia
• Restlessness
• ↑ anxiety
• Inappropriate behavior
• diaphoresis, tachycardia, and a widened pulse
pressure.
• Eczema, rashes, edema are allergic reactions that may
be noted with asthma.
Clinical Manifestations ofasthma
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15. Asthma diagnoses are based on symptoms and
classified into one of the following four
categories.
Mild intermittent – Symptoms occur less than
twice a week.
Mild persistent – Symptoms arise more than
twice a week but not daily.
Diagnosis
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16. cont
Moderate persistent – Daily symptoms occur in
conjunction with exacerbations twice a week.
Severe persistent – Symptoms occur continually,
along with frequent exacerbations that limit the
client’s physical activity and quality of life.
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17. o Pulmonary function tests
o Peak flow monitoring
o Chest x-ray
o ABGs
o Oximetry
o Allergy testing
o Blood levels of eosinophils
o Sputum culture and sensitivity
Investigations
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18. Non-Pharmacological Management
Discontinue smoking
Breathing exercises
Rehabilitation
Preventative measures.:
Patient education
Management
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19. 19logman

20. Patient-Centered Care
● Nursing Care
• Position the client to maximize ventilation
(high-Fowler’s = 90˚).
• Administer oxygen therapy as prescribed.
• Monitor cardiac rate and rhythm for changes
during an acute attack (can be irregular,
tachycardic, or with PVCs).
• Initiate and maintain IV access.
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21. cont
• Maintain a calm and reassuring demeanor.
• Provide rest periods for older adult clients
who have dyspnea. Design room and
walkways with opportunities for rest.
Incorporate rest into ADLs.
• Encourage prompt medical attention for
infections and appropriate vaccinations.
• Administer medications as prescribed.
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22. ●● Medications
• Bronchodilators (inhalers)
■ Short-acting beta2 agonists, such as albuterol
(Proventil, Ventolin), provide rapid relief of acute
symptoms and prevent exercise-induced asthma.
■ Anticholinergic medications, such as ipratropium
(Atrovent), block the parasympathetic nervous
system. This allows for the sympathetic nervous
system effects of increased bronchodilation and
decreased pulmonary secretions. These medications
are long-acting and used to prevent bronchospasms.
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23. cont
■ Methylxanthines, such as theophylline (Theo-
24), require close monitoring of serum medication
levels due to a narrow therapeutic range. Use only
when other treatments are ineffective.
■ Long-acting beta2 agonists, such as salmeterol
(Serevent), primarily are used for asthma attack
prevention.
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24. cont
■ Nursing Considerations
• Theophylline – Monitor the client’s serum
levels for toxicity. Side effects will include
tachycardia, nausea, and diarrhea.
• Albuterol – Watch the client for tremors and
tachycardia.
• Ipratropium – Observe the client for dry
mouth.
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25. ■ Client Education
• Ipratropium – Advise the client to suck on hard
candies to help relieve dry mouth; increase fluid
intake; and report headache, blurred vision, or
palpitations, which may indicate toxicity of
ipratropium. Monitor the client’s heart rate.
• Salmeterol – Advise client to use to prevent an
asthma attack and not at the onset of an attack.
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26. cont
• Anti-inflammatory agents
■ These are used to decrease airway
inflammation, and they include:
• Corticosteroids, such as fluticasone (Flovent)
and prednisone (Deltasone)
• Leukotriene antagonists, such as montelukast
(Singulair), mast cell stabilizers, such as
cromolyn sodium (Intal), and monoclonal
antibodies, such as omalizumab (Xolair)
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27. cont
■ Nursing Considerations
• Watch the client for decreased immunity
function.
• Monitor for hyperglycemia.
• Advise the client to report black, tarry stools.
• Observe the client for fluid retention and weight
gain. This can be common.
• Monitor the client’s throat and mouth for
aphthous lesions (canker sores).
• Omalizumab can cause anaphylaxis.
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28. cont
■ Client Education
• Encourage the client to drink plenty of fluids to
promote hydration.
• Encourage the client to take prednisone with food.
• Advise client to use this medication to prevent asthma,
not for the onset of an attack.
• Encourage client to avoid persons with respiratory
infections.
• Use good mouth care.
• Do not stop the use of this type of medication
suddenly.
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29. cont
• Combination agents (bronchodilator and anti-
inflammatory)
■ Ipratropium and albuterol (Combivent)
■ Fluticasone and salmeterol (Advair)
■ If prescribed separately for inhalation
administration at the same time, administer the
bronchodilator first in order to increase the
absorption of the anti-inflammatory agent.
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30. cont
Teamwork and Collaboration
• Respiratory services should be consulted for
inhalers and breathing treatments for airway
management.
• Nutritional services can be contacted for weight
loss or gain related to medications or diagnosis.
• Rehabilitation care can be consulted if the client
has prolonged weakness and needs assistance
with increasing level of activity.
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31. Complications
Respiratory failure
• Persistent hypoxemia related to asthma can
lead to respiratory failure.
Nursing Actions
■ Monitor oxygenation levels and acid-base
balance.
■ Prepare for intubation and mechanical
ventilation as indicated.
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32. cont
Status asthmaticus
• This is a life-threatening episode of airway
obstruction that is often unresponsive to
common treatment. It involves extreme
wheezing, labored breathing, use of accessory
muscles, distended neck veins, and creates a
risk for cardiac and/or respiratory arrest.
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33. cont
Nursing Actions
■ Prepare for emergency intubation.
■ As prescribed, administer oxygen,
bronchodilators, epinephrine, and initiate
systemic steroid therapy.
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