3. Introduction:
Asthma is chronic lung disease that inflames and
narrows the airway. Asthma is reversible, obstructive
airway disease in which trachea & bronchi respond in a
hyperactive way to certain stimuli.
It is a type of reversible bronchial disease in which
there is narrowing of bronchial lumen characterized
by wheezing & difficulty in breathing.
Asthma is a condition that affects the air passage of the
lung it is a three step problem
5. Types of asthma:
Allergic asthma( extrinsic asthma): the term allergic or
extrinsic asthma is used when the symptoms are induced by a
hyper immune response to the inhalation of specific allergens.
Allergic asthma is triggered by allergens such as pet dander ,
house dust, feathers, food preservatives
Allergic asthma is more likely to be a seasonal because it often
goes hand-in hand with allergies that are also seasonal.
Type-I (immediate)- hypersensitivity reaction is the basis of
the extrinsic asthma . During sensitization to allergens. IgE
.produced and binds to mast cell in the bronchial mucosa,
mast cells degranulated and release chemical mediators that
cause bronco spasm.
6. Non allergic asthma: (intrinsic asthma): this type of
asthma is triggered by irritants in the air that are not
released to allergies including air way irritants.( air
pollution, cold, heat, weather changes, fumes) wood or
cigarette smoke, room deodorants.
This type of irritants stimulate the parasympathetic nerve
fibbers in the airways causing broncho constriction and
inflammation.
Mixed asthma: mixed asthma has the characteristics of
both allergic and non allergic asthma.
7. Cough variant asthma: cough variant asthma does not have
the classical symptoms of asthma- such as wheezing and
shortness of breath. It is characterized by one symptoms, a
persistent dry cough.
Exercise induced asthma: EIA affects people during or after
physical activity.
Nocturnal asthma: this type of asthma is characterized by
asthma symptoms that worsen at night those who suffer from
nocturnal asthma can also experience symptoms at day also.
Occupational asthma:
It is induced by triggers that exists in a person’s work place
irritants and allergens include dusts, dyes, gases, fumes, animal
protein and rubber latex that are common in a wide range of
industries- including manufacturing textiles, farming, and
woodworking.
8. Causes & risk factor:
Airborne allergens.
Respiratory infection, such as common cold.
Physical activity.
Cold air
Air pollutants.
Certain medication, including beta blockers, aspirin and others NSAIDS
drugs.
Strong emotion and stress.
Gastroesophageal reflux disease.
Allergic reaction to some foods, such as peanuts or shellfish.
Low birth weight.
Weather, extreme changes in temperature.
Hay fever and other allergies.
Eczema
Genetic predisposition ( family history).
10. Clinical manifestation:
Coughing ( cough may be dry or wet ) and might be worsen at night.
Wheezing.
Chest tightness.
Shortness of breath.
Mucus production.
Fever, restlessness.
Headache.
Diaphoresis.
Nasal flaring.
Use of accessory muscle to breath.
Vomiting.
Hypoxemia.
Status asthmatics.
11. Diagnostic evaluation:
A detailed medical history and physical exam, focusing on the
chest and respiratory tract.
Pulse oximeter.
Methacholine challenge
Nitric oxide test
A chest X-ray or electrocardiogram.
Laboratory test.
Allergy blood testing.
Blood gases
CBC.
Sputum culture.
Sputum cytology
14. Nitric oxide test
An exhaled nitric oxide
level test can help
diagnose and manage
asthma. It measures the
amount of nitric oxide
that is exhaled from a
breath. Increased levels
of nitric oxide are
associated with swelling
of lung airways.
15. Asthma action plan:
Asthma action plan will document
important information such as your daily
medication ( what kind and when you
should take them). How to handle asthma
attack, and how to control your asthma
symptoms long term.
16.
17. Asthma zones:
According to severity three asthma zones are include;
Green zone: “ doing well”.
No asthma symptoms during the day or night.
Able to perform casual activities.
• Yellow zone: “ asthma is getting worse”
Showing symptoms such as coughing and wheezing or
shortnessofbreath.
Walking at night due to asthma symptoms.
Able to perform some but not all activities
Red zone: “ medical alert”
Extremely short breath.
Quick relief medication are not helping
Unable to perform normal activities.
Yellow zone symptoms same or worse for 24 hr.
18. Medical management:
GOAL:
Promote broncho dilation.
Reduce inflammation.
Remove secretion.
Prevent ongoing and bothersome symptoms.
Prevent asthma attack.
Maintain normal or near-normal lung function.
Have a few side effects of medication as possible.
Avoidance of triggers: the patient is instructed to avoid
asthma triggers. If triggers can not be avoided , the patient can
use bronchodilator or mast cell inhibitor metered dose
inhalers
19. Pharmacological therapy:
Long relief medication:
Inhaled corticosteroids: ex ,fluticasone, budesonide
Leukotriene modifiers: ex, zeieluton
Long acting beta antagonists(LABAs): Ex salmeterol &
formoterol.
Methylxanthines.: ex, theophyline and aminophyline.
Combination inhalers: ex, budenoside + formoterol
Cromolyn sodium.
Omalizumab.
20. Short relief medication:
Short acting beta antagonist:ex, albuterol,levalbuterol.
Ant cholinergic: ipratropium bromide.
Oral and intravenous corticosteroid: prednisone and
methylprednisone
22. Non pharmacological
interventions:
Oxygen therapy.
Postural drainage and chest physiotherapy.
Coughing and deep breathing exercises.
Avoidance of known allergens.
Breathing technique.
Relaxation technique.
Acupuncture.
23. Self care at home:
Avoid triggers.
Use air conditioner.
Reduce pet dander.
Clean regularly.
Get regular exercise.
Maintain a healthy weight.
Eat fruits and vegetables.
Do not take cough medicines.
Aspirin & non steroidal drug , such as ibuprofen can
cause asthma to worsen in certain individuals.
Do not use non prescription inhaler.
24. Nursing management of patient
with asthma:
patiets history
physical examination
Assess the patient’s respiratory status by monitoring the
severity of the symptoms.
Assess for breath sounds.
Assess the patient’s peak flow.
Assess the level of oxygen saturation through the pulse-
oximeter.
Monitor the patient’s vital signs.
25. Assess for sign & symptoms for atelectasis:
diminished chest excursion, limited
excursion , bronchial or tubular breath
sound.
Assess patients ability to cough effectively to
clear secretion. Not quantity, colour, and
consistency of sputum.
Assess patients knowledge of disease
process.
26. Nursing diagnosis:
impaired gas exchanger r/t altered oxygen supply, obstruction of airways,
bronchospam and air- trapping alveoli destruction as evidenced by
dyspnea, tachypnea and tachycardia.
ineffective airway clearance r/t bronchospasm, obstruction from narrowed
lumen, increed mucus production and respiratory infection as evidenced by
wheezing, dyspnea and cough.
imbalanced nutrition: less than body requirement related to dyspnea,
sputum production, anorexia , nausea and vomiting as evidenced by weight
loss.
activity intolerance may be related to imbalance between o2 supply and
demand, possibly evidenced by fatigue and exertional dyspnea.
risk for increasing attack of respiratory distress r/t expousre to allergens.
