2. Bronchial
asthma
• The word asthma means struggling for
breath. It is chronic inflammatory
disorder of the lower airway due to
temporary narrowing of the bronchi
by bronchospasm, manifested as
dyspnea, wheezing and excessive
cough
• The peak incidence is found in 5 to
10 years of age
3.
4. Etiological
factors
Predisposing factors:
• Heredity, with family history of
asthma or some other allergic
disorder
Excitatory factors:
• Allergy to certain foreign
substances
Inhalation of pollen, wool,
feather, animal hair, cotton
seeds, smoke, powder and dust
Ingestion of foods, like egg,
some fish etc.
Drugs like aspirin or penicillin
products
5. Classification
it is produced by a
hyperimmune response to
the inhalation of
specific allergen
(pollen, dust, feather,
etc). The condition
with extrinsic asthma
usually have positive
skin test to the
offending allergen and
a positive family
history of allergy.
• Non-Allergic or
intrinsic: it is
produced in response to
unidentified or
nonspecific factors of
the environment. No
hyperimmune system is
produced.
6. Clinical
Features
An attack of asthma usually beings fairly
suddenly.
Simple recurrent cough to severe Wheezing
Expiration is prolonged,
Shortness of breath is present.
Respiration is difficult but the rate is normal.
Patient become pale and cyanotic,
Cough and sputum production commonly occurs.
During severe attack, the neck veins bulge.
9. Inflammation and
edema of the
mucous membrane
lining the
airways
Excessive
secretions of
mucus,
inflammatory
cells and
cellular debris
Spasm of the
smooth muscle of
the bronchi
Obstruction is
diffused not
uniform
These processes
interfere with
ventilation and
produce the
clinical features
These events
contribute to
bronchial smooth
muscle
contraction and
airway narrowing.
10. Antigen antibody reaction is stimulated by
extrinsic triggers.
The antigen combines with IgE causing the mast cell
to degranulation and release chemical mediators
These chemical mediators act on bronchial smooth
muscle to cause bronchoconstriction,
11. • Inhalation of an allergen leads to a
biphasic response with early and late
reactions ultimately causing
bronchoconstriction.
EARLY REACTION : Starts within 10 min of
exposure to allergen. It is characterized
by release of histamine, leukotrienes,
prostaglandins, platelet activating factor
and bradykinin from the mast cells
following the interaction of allergen with
specific mast cell bound igE.
• All these substances cause
bronchoconstriction, mucosal edema and
mucus secretion which manifests as airway
12. LATE PHASE: occurs in
about two thirds of
patients. It develops 3-4
hr later and peaks at 8-
12 hrs
The release of mast cell
mediators is not prevented by
premedication with β2
agonist. However, it is
inhibited by premedication
with steroids suggesting that
airway narrowing is mainly
due to an inflammatory
reaction and mucosal edema.
13. Management of asthma should have the
following components:
• Identification and elimination of exacerbating
factors
• Pharmacological therapy
• Education of patients and parents.
14. Identification and elimination of exacerbating factors
Factors associated with development and precipitation of asthm
include passive smoking, allergic disorders, inadequate ventil
at home leading to dampness, cold air, cold food, smoke, dust
pets in the family
The bedroom of the child should be kept clean and free from du
possible. Wet mopping of the floor should be done because dry
dusting increases exposure of the child to house dust.
Furniture of the room should be clean periodically
Advised the adolescent patient to refrain from smoking.
15. • Bronchodilators: This group of drugs provides immediate
symptomatic relief. They may be short- acting
bronchodilators are adrenaline, terbutaline and
salbutamol. All of these have quick onset of action.
• Corticosteroids; being potent anti-inflammtory agents,
are useful for the long-term treatment.
• Mast cell stabilizers: cromolyn sodium reduces
bronchial reactivity and symptoms induced by irritants,
antigens and exercise. Ketotifen is mast cell
stabilizer. It is administered orally. Significant
clinical improvement may be evident after 14 weeks of
therapy.
• Leukotriene modifiers
• Theophylline: has bronchodilator effects
• Immunotherapy:
16. Education of
patients and
parents.
• Education of parents is an important aspect of
asthma treatment.
• A description of the pathogenesis of asthma in
plain language should be made.
• Parents also need to be involved in the steps
required to minimize exposure to potential
environment triggers
• Parents are also asked to maintain a record of
daily symptoms such as cough , wheezing and
breathlessness.
• The parents should understand how the medicine
work and how to take the medicine.
17. Status
asthmaticus
• Status asthmaticus is considered a
medical emergency. It is the extreme form
of an asthma exacerbation that can result
in hypoxemia, hypercarbia, and secondary
respiratory failure.
• In this condition wheezing continues for
hours to days, in spite of
administration of bronchodilators.
• It is severe form of asthma in which the
airway obstruction is unresponsive to
usual drug therapy.
• It is medical emergency and should be
treated with intensive care.
18. • Tachypnea, labored respirations with
suprasternal retraction and use of
accessory muscle of respiration.
• Decreased ability to speak in phrases
or sentences, anxiety, irritability
fatigue, headache, diaphoresis
• Tachycardia and elevated blood
pressure is found.
• Heart failure and death from
suffocation usually develop.
19.
20. In case of status asthmaticus
• Immediate hospitalization is required
considering the condition as medical
emergency.
• Management of such patient should be
done with aminophylline or
theophylline infusion, IV
corticosteroids and aerosol therapy
with continuous monitoring by pulse
oximetry, ABG analysis etc.
• The child may need intensive care unit
care with ventilator support.
21. • Chest physiotherapy, postural
drainage and breathing exercise.
• Change of environment to avoid
environmental allergens and
psychological stress
22. Nursing management
• Nursing care of the children with asthma
involves skillful assessment and innovative
approaches to assist the child toward optimal
respiratory functioning, growth and
development.
• The goal of nursing care in a patient’s having
an asthma attack is to make sure there is
adequate oxygen intake
• Evaluate respiratory rate/depth and breath
sounds
• Assist client to maintain a comfortable
position and Encourage/instruct in deep-
23. • Providing emotional support and
necessary instruction. Calm and quiet
approach, trusting relationship,
explanation, reassurance, play and
recreation and parenteral
participations are important aspect.
• Administer medication on time: drugs
can be given orally, parenteral or
through inhalation devices. Nebulizers
should be used with appropriate
technique
• For IV medication children’s condition
must be closely monitored.
24. • Administer fluid therapy: during asthmatic attack,
child is usually having less fluid intake,
abdominal discomfort, vomiting and increased
insensible
• Maintaining adequate dietary intake: clear liquids
to be given in small amount frequently. Forced
feeding and large amount may lead to abdominal
discomfort and vomiting. Allergic food should be
avoided. Balanced diet should be planned to provide
adequate nutrients for maintenance of health and to
promote growth when the acute phase is over.
25. • Providing rest and sleep: adequate rest and sleep
should be provided to relief from labored
respiration.
• Maintenance of hygienic measures: routine hygiene
care, dust free environment, prevention of accidents
and promotion of safety measures.
• Supporting parents and family members
