Respiratory system of CHN

1. BRONCHIAL
ASTHMA

2. Asthma is a chronic
inflammatory disorder of the
airways in which many cells (mass
cells, eosinophils and T
lymphocytes) play a role resulting
in episodic air flow obstruction.

3. DEFINITIO
N

4. CHRONIC DISEASE OF THE
AIRWAYS THAT MAY CAUSE
1. Wheezing
2. Breathlessness
3. Chest tightness
4. Night time or early morning
coughing

5. • Most of cases have origin in first
2years of life, peak incidence is seen
in 5-10 years of age
• Boys suffer twice as much as girls
• Prevalence of asthma among
children is about 2-18.2%
INCIDENCE & PREVALENCE

7. □ ASTHMA
TRIGGERS
□ Animal dander
□ Indoor allergens
□ Dust mites
□ Cockroaches
□ Molds
□ Seasonal
aeroallergens

8. □Pollens (trees, grasses,
weeds)
□Seasonal molds
□Environmental tobacco
smoke
□Air pollutants
□Sulfur dioxide
□Wood- or coal-burning
smoke

9. □ Endotoxin, mycotoxins
□ Dust
□ Strong or noxious odors or fumes
□ Cold air, dry air
□ Exercise
□ Crying, laughter, hyperventilation
□ Co-morbid conditions
□ Rhinitis
□ Sinusitis
□ Gastroesophageal reflux

13. Airway with inflammation Airway with
bronchospasm,and
inflammation,
mucus
production

16. ASTHMA - SEVERITY CLASSIFICATION
IN CHILDREN
1. Intermittent asthma
2. Mild persistent
asthma
3. Moderate persistent asthma
4. Severe persistent
asthma
1. INTERMITTENT ASTHMA
□ Symptoms less than 2 days/week
□ Night time awakening: none
□ Interference with normal activity: none

17. MILD PERSISTENT ASTHMA
□ Symptoms more than 2 days/week
□ Night time awakening: 1 to 2 times
a month
□ Interference with normal activity:
minor limitation

18. MODERATE PERSISTENT
ASTHMA
□ Daily symptoms
□ Night time awakening: 3 to 4 times
a month
□ Interference with normal activity:
some limitation

19. SEVERE PERSISTENT ASTHMA
□ Continual symptoms through out
the day
□ Frequent night time symptoms
□ Interference with normal activity:
extremely limited

20. CLINICAL MANIFESTATION

21. • HISTORY COLLECTION
• PHYSICAL EXAMINATION
DIAGNOSTIC EVALUATION

22. 1. Pulmonary function test
(PFT)
provides an objective method of evaluating the
presence and degree of lung diseases as
well as response to therapy.
Peak expiratory flowrate (PEFR), Forced
expiratory volume (FEV) and forced vital
capacity are measured. All parameters
are absent in asthma

23. 2. SPIROMETRY
generally be performed reliably on children
by the age of 5 to 6 years.
3. Chest X ray
Air trapping in lungs.
Atelectasis

24. 3. Peak expiratory flow rate (PEFR)
measures the maximum flow of air that can
be forcefully exhaled in 1 second. (PEFR) is
measured in litres per min using a peak
expiratory flow meter (PEFM)
4. Broncho-provocation testing: helps
to identify inhaled allergen.

25. 5. EXERCISE
CHALLENGE:
identify children with exercise induced
bronchospasm
6. Skin testing:
identify specific allergens. RAST
(radioallergosorbent test) helps to identify
antigens against various foods and is often
useful in determining appropriate therapy.

26. 8. Chest radiography:
shows infiltration and hyper-expansion
of the airways.
7. LABORATORY TEST: CBC

27. THERAPEUTIC MANAGEMENT
The overall goals of asthma management are
1. Maintain normal activity level
2. Maintain normal pulmonary functions
3. Prevent chronic symptoms and recurrent
exacerbations
4. Provide optimum drug therapy with minimum
or no adverse effects
5. Assist the child in living as normal and happy
life
6. To accomplished these goals several treatment
principles need to be followed

28. □ ALLERGEN CONTROL:
Reduce the exposure to air-borne
allergens and irritants. E.g. house dust
mites, cockroaches, mouse allergens, cat
and dog dander, tobacco smoke, wood
burning stoves, pesticides lead, nitrogen
dioxide and sulphur dioxide
Skin test to identify specifies specific
allergens

29. □ Allergy proofing:
□ Keep humidity between 30% to 50%
□ Encase pillows and mattress in zippered
allergen-impermeable covers
□ Wash pillow in hot water every week
□ Use synthetic blankets
□ Do not use canopy above the bed
□ Children should not sleep on the bottom bunk
of a bunk bed
□ Store nothing under the bed; keep clothing in a
closet with the door shut.

30. □ Remove all carpeting if possible; if not possible
vacuum the carpet once or twice a week
□ Remove unnecessary furniture, rugs, toys,
books wall hanging from child room
□ Limit child’s exposure to animal, tobacco and
wood smoke
□ Keep window and doors closed during pollen
seasons.
□ Avoid odours or sprays

31. DRUG THERAPY
ASTHMA MEDICATIONS ARE
CATEGORIZED INTO TWO
GENERAL CLASSES:
□ Long term control medications (preventive
medications): to achieve and maintain control
inflammation
□ Quick relief medications (rescue medications):
to treat symptoms and exacerbations.
The above medications are often used in
combination. Many asthma medications are given
by inhalation with a nebulizer or a metered dose
inhaler (MDI)

32. 1. CORTICOSTEROID:
2. anti-inflammatory drugs used to treat
reversible airflow obstruction and to
control symptoms and reduce bronchial
hyper-responsiveness in chronic
asthma. It may be administered
parenterally, orally or by inhalation.
Cromolyn sodium is a non steroidal
inflammatory drug (NSAID) for
asthma

33. 2. ß- ADRENERGIC AGONISTS:
primarily albuterol, levalbuterol and
terbutaline are used for treating acute
exacerbations and for the prevention of
exercise-induced bronchospasm. These
drugs can be given via inhalation or as
oral or parenteral preparations
□ Salmeterol (Serevent) is a long acting
ß2-agonist (bronchodilator) that is used
twice a day

34. 3. ANTICHOLINERGICS: Atropine
and atrovent may also be used for
relief of acute bronchospasm.
The primary anticholinergic drug used
is atrovent, which does not cross the
blood brain barrier. And therefore
elicits no central nervous system
effects.

35. USING ASTHMA MEDICATION DELIVERY DEVICES
NEBULIZER

36. METERED-DOSE INHALER
Put the spacer
mouthpiece in
the mouth (or
place the mask
over the child’s
nose and mouth,
ensuring a good
seal).
Attach the
inhaler
to the spacer
or
holding
chamber.
•Breathe out
completely.
• Compress the
inhaler and inhale
slowly and deeply.
Hold the breath
for a count of 10.

37. EXERCISE
□Exercise induced bronchospasm
(EIB) is an acute, reversible, usually
self-terminating airway obstruction
that develops during or after vigorous
activity, reaches its peak 5 to 10
minutes after stopping the activity,
and usually stops in another 20 to 30
minutes.

38. □CHILDREN WITH ASTHMAARE
OFTEN EXCLUDED FROM
EXERCISE BY PARENTS,
TEACHERS AND PRACTITIONERS
AS WELL AS BY THE CHILDREN
THEMSELVES, SINCE THEY ARE
RELUCTANT TO PROVOKE AN
ATTACK.

39. CHEST PHYSICALACTIVITY
□This includes breathing exercise and
physical training. It helps to produce
physical and mental relaxation, improved
posture, strengthens respiratory
musculature and develop more efficient
pattern of breathing. However CPT is
not recommended during acute,
uncomplicated exacerbations of
asthma.

40. HYPOSENSITIZATION
immunotherapy for asthma patients in the
following situations:
□ When there is evidence of a relationship
between asthma symptoms and avoidable
exposure to an allergen to which the
patient is sensitive.
□ When symptoms occurs all year
□ When symptom control is difficult with
drug therapy

41. STATUS ASTHMATICUS
□Children who continue to display
respiratory distress despite vigorous
therapeutic measures especially the use
of sympatho-mimetics (e.g. albuterol,
epinephrine), are considered to be in
status asthmaticus. The condition may
develop gradually or rapidly often
coincides with complication such as
pneumonia or respiratory virus.

42. Therapy: the aimed is to
□Improved ventilation
□Decreased airway resistance and
relieve bronchospasm
□Correcting dehydration and acidosis.
□Allays child and parent anxiety
□Treating any concurrent infection

43. □ 1. Humidified oxygen is recommended
□ 2. Inhaled aerosolized: Short acting
ß2-agonist (bronchodilator) is
recommended
□ 3. Systemic corticosteroid to decrease the
effect of inflammation
□ 4. Correction of dehydration, acidosis,
and hypoxia and electrolyte disturbance is
guided by frequent determination of
arterial pH, blood gases and serum
electrolytes.

44. □5. Additional therapy
IV magnesium sulphate, a potent muscle
relaxant that acts to decrease inflammation
and improves pulmonary function.
Heliox may be administered to decrease airway
resistance and thereby decreased the work of
breathing.
□6. Antibiotics should not be used to treat acute
asthma attacks except when a bacterial
infection resulting from other conditions such
as pneumonia and sinusitis.

45. NURSING CARE MANAGEMENT
□ This may include asthma education in a primary care
setting and in school and other community setting, care of
the child with asthma in the acute care setting, ambulatory
care and intensive care.
□ Nurses can also obtain information on how asthma affects
the child’s everyday activities and self concept.
□ The nurse should also assess their perception of the severity
of the disease and their level of social support.
□ Parents are taught how to avoid allergens, to recognize and
response to symptoms of bronchospasm, to maintain health
and prevent complication and to promote normal activities.

46. NURSING DIAGNOSIS
□ Ineffective breathing related to inflammatory process
□ Ineffective airways clearance related to mechanical
obstruction, inflammation, increased secretion
□ Activity intolerance related to inflammatory process,
imbalance between oxygen supply and demand
□ Risk for infection related to presence of infectious
organisms
□ Risk for suffocation related to interaction between
individual and triggering factors
□ Interrupted family processes related to child with a
chronic illness

47. INTERVENTION
□ Avoid allergen.
□ Food known to provoke symptoms should be
eliminated from the diet
□ The child should be protected from respiratory tract
infection especially in children whose airways are
mechanically smaller and more reactive.
□ Relieve bronchospasm: Parents and older children are
taught to recognise the early sign and symptoms of
attack so that it can be controlled before symptoms
become distressing.

48. □ Annual influenza vaccinations are recommended for
children with persistence asthma ( American
Academy of paediatrics)
□ Equipment used for the child such as nebulizers, must
be kept absolutely clean.
□ Breathing exercises and controlled breathing are
taught and encouraged for motivated children
□ Play techniques that can be used for younger children
to extend their expiatory time and increased
expiratory pressure include blowing cotton balls,
blowing bubbles or preventing the tissue from falling
by blowing it against the wall.

49. □Asthma camps provide an opportunity for
children with asthma to engage in physical
activity while learning about their disease in a
controlled environment with their peer and
health professionals. Children who attend
asthma camps often demonstrate improved
asthma self management skills.
□ Support child or adolescent and family:
parents need reassurance and want to be
informed of theirs child condition and
therapies.

50. THANK
YOU