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Asthma
- 1. BRONCHIAL ASTHMA DR.BANU CHANDERPANDIAN .S DNB FAMILY MEDICINE RESIDENT KG HOSPITAL
- 2. Asthma Definition Reactive obstructiveairway disease Chronic inflammatory lung disease Inflammation causes varying degrees of obstruction in theInflammation causes varying degrees of obstruction in the airwaysairways Asthma is reversible in early stages
- 3. Triggers of Asthma AllergensAllergens ExerciseExercise Respiratory InfectionsRespiratory Infections Nose and Sinus problemsNose and Sinus problems Drugs and Food AdditivesDrugs and Food Additives GERDGERD Emotional StressEmotional Stress
- 5. Early and LatePhases of Responses of Asthma Fig. 28--1
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- 7. Asthma Pathophysiology Early-Phase ResponseEarly-Phase Response PPeaks 30-60 minutes post exposure, subsides 30-90 minutes later Characterized primarily by bronchospasm Increased mucous secretion, edema formation, and increased amounts of tenacious sputum Patient experiences wheezing, cough, chest tightness, and dyspnea
- 8. Asthma Pathophysiology Late-Phase ResponseLate-Phase Response Characterized primarily by inflammationCharacterized primarily by inflammation Histamine and other mediators set up a self- sustaining cycle increasing airway reactivity causing hyperresponsiveness to allergens and other stimuli Increased airway resistance leads to air trapping in alveoli and hyperinflation of the lungs If airway inflammation is not treated or does not resolve, may lead to irreversible lung damage
- 10. Summary of PathophysiologicFeatures Reduction in airway diameter Increase in airway resistance r/t Mucosal inflammation Constriction of smooth muscle Excess mucus production
- 11. Asthma Clinical Manifestations Unpredictable andvariable Recurrent episodes of wheezing, breathlessness, cough, and tight chest
- 12. Asthma Clinical Manifestations Expiration maybe prolonged from a inspiration- expiration ratio of 1:2 to 1:3 or 1:4 Between attacks may be asymptomatic with normal or near-normal lung function
- 13. Asthma Clinical Manifestations Wheezing isan unreliable sign to gauge severity of attack Severe attacks can have no audible wheezing due to reduction in airflow “Silent chest” is ominous sign of impending respiratory failure
- 14. Asthma Clinical Manifestations Difficulty withair movement can create a feeling of suffocation Patient may feel increasingly anxious Mobilizing secretions may become difficult
- 15. Asthma Clinical Manifestations Examination ofthe patient during an acute attack usually reveals signs of hypoxemia Restlessness Increased anxiety Inappropriate behavior Increased pulse and blood pressure Pulsus paradoxus (drop in systolic BP during inspiratory cycle >10)
- 17. Asthma Complications Status asthmaticus Severe, life-threateningattack refractory to usual treatment where patient poses risk for respiratory failure
- 18. ASSESEMENT OF SEVEREASTHMA PEF 33 -50% Respitatory rate > 25 Heart rate > 110/min Inability to compleate sentence in 1 breath
- 19. LIFE THREATENING FEATURE PEF 33 – 50 % Spo2 < 92% or pao2 < 60mmhg Normal paco2 Silent chest Cyanosis Feeble respiratory effort Bradycardia or arrhythmia Hypotension Exhaustion Confusion Coma
- 20. Nearly fatal asthma Raisedpaco2 Requring mechanical ventillation with raised inflation pressure
- 21. Asthma Diagnostic Studies Detailed historyand physical exam Pulmonary function tests Peak flow monitoring Chest x-ray ABGs
- 26. Asthma Diagnostic Studies Oximetry Allergy testing Bloodlevels of eosinophils Sputum culture and sensitivity
- 27. Asthma Drug Therapy BronchodilatorsBronchodilators ββ-adrenergic agonists-adrenergic agonists (e.g., salbutamol,)(e.g., salbutamol,) Acts in minutes, lasts 4 to 8 hours Short-term relief of bronchoconstriction Treatment of choice in acute exacerbations
- 28. Asthma Drug Therapy BronchodilatorsBronchodilators Useful in preventing bronchospasm precipitated by exercise and other stimuli Overuse may cause rebound bronchospasm Too frequent use indicates poor asthma control and may mask severity
- 29. Asthma Drug Therapy Bronchodilators(longer acting)Bronchodilators (longer acting) 8 – 12 or 24 hr; useful for nocturnal asthma Avoid contact with tongue to decrease side effects Can be used in combination therapy with inhaled corticosteroid
- 30. Asthma Drug Therapy Antiinflammatory drugsAntiinflammatorydrugs Corticosteroids (e.g., beclomethasone, budesonide)Corticosteroids (e.g., beclomethasone, budesonide) Suppress inflammatory response Inhaled form is used in long-term control Systemic form to control exacerbations and manage persistent asthma
- 31. Asthma Drug Therapy Anti-inflammatory drugsAnti-inflammatorydrugs Mast cell stabilizers (e.g.,sodium cromoglycate,Mast cell stabilizers (e.g.,sodium cromoglycate, nedocromil)nedocromil) Inhibit release of histamineInhibit release of histamine Inhibit late-phase response Long-term administration can prevent and reduce bronchial hyper-reactivity Effective in exercise-induced asthma when used 10 to 20 minutes before exercise
- 32. Asthma Drug Therapy Antiinflammatory drugsAntiinflammatorydrugs CorticosteroidsCorticosteroids Do not block immediate response to allergens, irritants, or exercise Do block late-phase response to subsequent bronchial hyperresponsiveness Inhibit release of mediators from macrophages and eosinophils
- 33. Asthma Drug Therapy Leukotriene antagonist(e.g. montelukast, zafirlukast) Leukotriene – potent bronchco-constrictors and may cause airway edema and inflammation Have broncho-dilator and anti-inflammatory effects
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- 38. TREATMENT OXYGEN maintain saturationabove 92 % High dose inhalation bronchodilator Short acting beta2 blockers Plus ipatropium bromide Systemic steroid Prednisolone 30 – 60mg Iv hydrocortisone 200mg IVF – potassium suppliment IV magnesium
- 39. INDICATION FOR VENTILLATION Coma Respiratoryarrest ABG Pao2 < 60 mmhg Paco2 > 45mmhg Ph low and falling Exhaustion,confusion,drowsiness
- 41. Nursing Management Nursing Diagnoses Ineffectiveairway clearance Anxiety Ineffective therapeutic regimen management
- 42. Nursing Management Planning Normal ornear-normal pulmonary function Normal activity levels No recurrent exacerbations of asthma or decreased incidence of asthma attacks Adequate knowledge to participate in and carry out management
- 43. Asthma Collaborative Care Acute AsthmaEpisodeAcute Asthma Episode Therapy should continue until patient • is breathing comfortably • wheezing has disappeared • pulmonary function study results are near baseline values
- 44. Nursing Management Health Promotion Teachpatient to identify and avoid known triggers Use dust covers Use of scarves or masks for cold air Avoid aspirin or NSAIDs Desensitization can decrease sensitivity to allergens
- 45. Asthma Patient Teaching Relatedto Drug Therapy Correct administration of drugs is a major factor inCorrect administration of drugs is a major factor in determining success in asthma managementdetermining success in asthma management Some persons may have difficulty using an MDI and therefore should use a spacer or nebulizer DPI (dry powder inhaler) requires less manual dexterity and coordination
- 46. Asthma Collaborative Care Status asthmaticusStatusasthmaticus IV corticosteroids Continuous monitoring Supplemental O2 to achieve values of 90% IV fluids are given due to insensible loss of fluids Mechanical ventilation is required if there is no response to treatment
- 47. Asthma Patient Teaching Relatedto Drug Therapy Inhalers should be cleaned by removing dust cap and rinsing with warm water β-adrenergic agonists should be taken first if taking in conjunction with corticosteroids
- 48. Nursing Management Health Promotion Promptdiagnosis and treatment of upper respiratory infections and sinusitis may prevent exacerbation Fluid intake of 2 to 3L every day
- 49. Nursing Management Health Promotion Adequatenutrition Adequate sleep Take β-adrenergic agonist 10 to 20 minutes prior to exercising
- 50. Nursing Management Nursing Implementation AcuteIntervention Monitor respiratory and cardiovascular systems Lung sounds Respiratory rate Pulse BP
- 51. Nursing Management Nursing Implementation ABGs Pulse oximetry FEV and PEFR Work of breathing Response to therapy
- 52. Asthma Collaborative Care Education Startat time of diagnosis Integrated into every step of clinical care Self-management Tailored to needs of patient Emphasis on evaluating outcome in terms of patient’s perceptions of improvement
- 53. Nursing Management Nursing Implementation Nursing InterventionsNursing Interventions Administer O2 Bronchodilators Chest physiotherapy Medications (as ordered) Ongoing patient monitoring
- 54. Nursing Management Nursing Implementation Animportant goal of nursing is to decrease theAn important goal of nursing is to decrease the patient’s sense of panicpatient’s sense of panic Stay with patient Encourage slow breathing using pursed lips for prolonged expiration Position comfortably
- 55. Nursing Management Nursing Implementation The patient must learn about medications and develop self- management strategies Patient and health care professional must monitor responsiveness to medication Patient must understand importance of continuing medication when symptoms are not present
- 56. Nursing Management Nursing Implementation Importantpatient teaching: Seek medical attention for bronchospasm or when severe side effects occur Maintain good nutrition Exercise within limits of tolerance
- 57. Nursing Management Nursing Implementation Importantpatient teaching (cont.): Patient must learn to measure their peak flow at least daily Asthmatics frequently do not perceive changes in their breathing
- 58. Nursing Management Nursing Implementation Counselingmay be indicated to resolve problems Relaxation therapies may help relax respiratory muscles and decrease respiratory rate
- 59. Nursing Management Nursing Implementation PeakFlow ResultsPeak Flow Results GreenGreen zonezone Usually 80-100% of personal best Remain on medications
- 60. Nursing Management Nursing Implementation PeakFlow ResultsPeak Flow Results Yellow zoneYellow zone Usually 50-80% of personal best Indicates caution Something is triggering asthma
- 61. Nursing Management Nursing Implementation PeakFlow ResultsPeak Flow Results Red zoneRed zone 50% or less of personal best Indicates serious problem Definitive action must be taken with health care provider
- 62. Asthma Drug Therapy Long-term controlmedications Achieve and maintain control of persistent asthma Quick-relief medications Treat symptoms of exacerbations
- 63. Asthma Collaborative Care Acute AsthmaEpisodeAcute Asthma Episode O2therapy should be started and monitored with pulse oximetry or ABGs in severe cases Inhaled β-adrenergic agonists by metered dose using a spacer or nebulizer Corticosteroids indicated if initial response is insufficient
- 64. Asthma Collaborative Care Status asthmaticusStatusasthmaticus Most therapeutic measures are the same as for acute Increased frequency & dose of bronchodilators Continuous β-adrenergic agonist nebulizer therapy may be given