Asthma is a chronic lung disease characterized by airway inflammation, obstruction due to muscle spasm, and mucosal edema caused by hypersensitivity to irritants. It is caused by both genetic and environmental factors like allergens, infections, climate, diet, pollutants, and drugs. Symptoms include dyspnea, wheezing, and cough. Diagnosis is based on patient history and examination. Treatment involves quick relievers for acute attacks and preventers like steroids to control inflammation and prevent further attacks. Nursing management focuses on education, environmental control, evaluation, emotional support, and regular follow-up.

2. DEFINITION
Asthma is a non-communicable chronic lung disease, characterized by
the following features:
• Airway inflammation
• Airway obstruction mainly due to muscle spasm
• Mucosal edema due to the hyper-reactivity to aerobiological irritants.

4. ETIOLOGY
1. Host factors:
• Genetic: Genes predisposing to airway hyper responsiveness
• Sex: More in males, 2:1
• Psychosocial factors: Anxiety, Stress
• Weakened immune system, illness
• Exercise

5. CONT..
2. Environmental factors:
• Allergens: Domestic mites, animals dander, fungi, Pollens, yeasts.
• Infections: Predominantly viral in 40% of children.
• Climate: Seasonal variation (winter) of asthma attacks is experienced by
35% of children.
• Diet: certain foods also trigger it (peanuts, eggs, wheat, shellfish).
• Pollutants: tobacco smoke, mosquito coil smoke, sprays, perfumes etc.
• Drugs: aspirin, beta blockers.

7. TYPES
1. Based on duration
• Intermittent: asthma comes and goes, so the person feels normal in
between asthma flares.
• Persistent: symptoms are present much of the time with varying of
intensity (mild, moderate, severe).
2. Based on etiology
• Allergic: when allergens cause asthma (mites, pollen, dust)
• Nonallergic: asthma due to outside factors like stress, exercise, illness,
weather.
3. Based on age
• Adult onset: starts after the age of 18 years.
• Childhood: begins before the age of 5, mostly in infants and toddler

8. PATHOPHYSIOLOGY

10. CLINICAL MANIFESTATIONS
1. The classical manifestations are:
• Dyspnea, wheezing & cough.
• The episode of asthma usually begins with the child feeling
irritable & increasingly restless.
• Nocturnal Cough/Breathlessness.
• Others complain headache, feeling tired & chest tightness.

11. CONT..
2. Respiratory symptoms:
• Recurrent cough
• Post-tussive vomiting (vomiting after a bout of coughing) occurs in 5%
of cases.
• Abdominal pain: due to over-working of expiratory abdominal muscles.
• Chest pain is present rarely.
• Other comorbid conditions like allergic rhinitis, sinusitis, otitis media,
eczema etc.
• Shortness of breath, prolonged expiration, wheezy chest, cyanosis.

12. DIAGNOSTIC EVALUATIONS
1. History taking (Ask)
• Has the child had an attack or recurrent episode of wheezing?
• Does the child have a troublesome cough which is particularly worse at
night?
• Is the child awakened by coughing or difficult breathing?
• Does the child cough or wheeze after physical activity (like games and
exercise) or excessive crying?
• Does the child experience breathing problems during a particular season?

13. CONT..
2. Physical Examination (Look).
• Dyspnea, Expiratory wheeze, Accessory muscle movement,
• Difficulty in feeding, talking, getting to sleep
• Irritability to Cough
• Eczema, Allergic Rhinitis
3. Chest x ray: Chest X-ray is not needed to diagnose asthma. It is needed
only when the diagnosis is not clear or any complications are suspected.

15. MEDICAL MANAGEMENT
1. Oxygen: Give oxygen to keep oxygen saturation > 95% in all.
2. Pharmacotherapy:
• Quick relievers: Used for acute attacks to relieve bronchospasm when
needed. E.g. Salbutamol, Terbutaline, Adrenaline, Aminophylline
• Preventers/long term control medicines: Used to control the
inflammation and to prevent further attacks.
- Steroids (Oral and Inhaled) like prednisolone.
- Bronchodilator :Theophylline, magnesium sulfate (severe asthma)

16. NURSING MANAGEMENT
The management of asthma includes:
• Education
• Environment control
• Evaluation
• Emotional support
• Regular follow-up.

17. CONT..
1. Education: Clear the misconceptions about the disease, sexual bias, non-
communicability of the disease, fear of inhalers, steroids etc.
2. Environment Control: The aim should be to avoid allergens and irritants:
• Dust mites: Avoid carpets, use plastic covers to pillows and mattresses;
and expose to sunlight once a week; wash soft toys periodically; and wet
mop the floorings.
• Cockroach: Cover garbage and unused food containers.
• Fungus: Attend to damp walls, have good ventilation and clean the shower
curtains weekly.
• Pets: Keep them away from sleeping area, if possible outside the house.
• Avoid strong odors, smoke, mosquito coil burning, and especially tobacco
smoke.

18. CONT..
3. Evaluation
• Frequent assessment of respiratory pattern.
• Cyanosis
• Breath sounds
• Vital signs
• Cerebral functions

19. CONT..
4. Providing emotional support:
• Calm and quiet approach
• Trusting relationship
• Reassurance
• Play and recreation
• Parental participations
5. Positioning:- Comfortable sitting position and supporting with pillow.

20. CONT..
6. Administering fluid therapy:
• During asthma they take less fluid.
• Vomiting and insensible loss due to hyperventilation.
• Clear liquids in small amounts.
• Intravenous fluid administration
• Maintain input output chart
7. Maintaining adequate dietary intake:
• Allergic foods to be avoided.
• Spicy and gas forming foods to be avoided.
• Balanced diet in small amount and frequent interval.

21. CONT..
8. Maintenance of hygienic measures
• Routine hygiene care.
• Aseptic technique.
9. Supporting parents and family
• Emotional support
• Parent participation in care
• Discuss treatment plan.
10. Follow-up care

22. COMPLICATIONS
• Pneumonia
• Respiratory failure