A SEMINAR TOPIC ON ASTHMA

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TABLE OF CONTENTS

INTRODUCTION

DEFINITION

CAUSES

PATHOPHYSIOLOGY

CLINICAL MANIFESTATION

DIAGNOSTIC INVESTIGATION

MEDICAL MANAGEMENT

NURSING MANAGEMENT

COMPLICATIONS

PREVENTION

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 ASTHMA

INTRODUCTION

The airways become obstructed from either inflammation of the lining of the airways or

constriction of the bronchial smooth muscles (bronchospasm). A known allergen, for

example, pollen—is inhaled, causing activation of antibodies that recognize the allergen.

Mast cells and histamine are activated, initiating a local inflammatory response.

Prostaglandins enhance the effect of histamine. Leukotrienes also respond, enhancing the

inflammatory response. White blood cells responding to the area release inflammatory

mediators.

A stimulus causes an inflammatory reaction, increasing the size of the bronchial linings; this

results in restriction of the airways. There may be a bronchial smooth muscle reaction at the

same time.

DEFINITION

Asthma is a chronic inflammatory disease of the airways characterized by hyper-

responsiveness, mucosal oedema, and mucus production. This inflammation ultimately leads

to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnoea.

Patients with asthma may experience symptom-free periods alternating with acute

exacerbations that last rom minutes to hours or days.

It is also a lung disorder characterized by narrowing of the airways, the tubes which carry air

into the lungs that are inflamed and constricted, causing shortness of breath, wheezing and

cough.

Asthma, the most common chronic disease of childhood can begin at any age. Risk factors

for asthma include family history, allergy (strongest factor), and chronic exposure to airway

irritants or allergens (e.g., grass, weed pollens, Mold, dust, or animals). Common triggers for

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asthma symptoms and exacerbations include airway irritants (e.g., pollutants, cold, heat,

strong odours, smoke, and perfumes), exercise, stress or emotional upset, rhinosinusitis with

postnasal drip, medications, viral respiratory tract infections, and gastroesophageal reflux.

There are two kinds of asthma:

 Extrinsic asthma, also known as atopic, caused by allergens such as pollen, animal

dander, mold, or dust. Often accompanied by allergic rhinitis and eczema; this may

run in families.

 Intrinsic asthma, also known as non-atopic, caused by non-allergic factor such as

following a respiratory tract infection, exposure to cold air, changes in air humidity,

or respiratory irritants

CAUSES

The causes of asthma are unknown, but it is most probably due to either genetic or

environmental factors. Certain factors are known to trigger asthmatic symptoms they are:

 Allergens like dust mites, animal dander, pollen, molds, cigarette smoke, chemical

pollutants, and cold air

 Sinusitis

 Extreme emotional responses and physical exercise

 Medications like aspirin, beta-blockers or NSAIDs

 Gastro oesophageal reflux disease

 Other factors like dietary insufficiencies in vitamins C and E, and omega-3 fatty acids

 Foods with sulphites and preservatives may also trigger symptoms

Few factors are associated with the development of asthma, they are

 Motherhood at a young age

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  Poor maternal nutrition

 Premature birth

 Low birth weight

 Smoking

 Overweight

PATHOPHYSIOLOGY

Airway inflammation, with associated airway hyper responsiveness, is the underlying feature

of asthma irrespective of whether symptoms are triggered by exposure to allergy, irritants or

a combination of both. Airway hyper responsiveness causes an ‘overresponse’ of the airways

to a wide range of stimuli such as allergens and irritants, resulting in a narrowing of the

airways and variable airflow limitation with intermittent symptoms.

Persistent inflammation results in increased smooth muscle, a proliferation of blood vessels

in the airway walls and an increased number of mucus-producing goblet cells

CLINICAL MANIFESTATION

These include:

 Wheezing initially present on expiration continues throughout respiratory cycle as

inflammation progresses. Air has difficulty moving through the narrowed airways,

making noise. Not all asthmatics will have wheezing.

 Asymptomatic between asthma attacks. Symptoms resolve when there is no

inflammation present.

 Difficulty breathing (dyspnoea) as airways narrow due to inflammation. This is

typically progressive as inflammation increases.

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  Respiration greater than 20 breaths per minute (tachypnea) as the body to get more

oxygen into the lungs to meet physiologic needs.

 Use of accessory muscles to breathe as the body tries harder to get more air into the

lungs.

 Tightness in the chest due to narrowing of the airways (bronchoconstriction).

 Cough.

 Tachycardia—heart rate greater than 100, as the body attempts to get more oxygen to

the tissues.

DIAGNOSTIC INVESTIGATION

Diagnosis involves:

 A medical history- History taking

 A physical examination

 Peak flow rate: Peak flow assesses airway obstruction by measuring the air out of

lungs while breathing. The air flow will be lower in asthmatic patients.

 Spirometry: This test is done to confirm the presence of airway obstruction. This

estimates the functioning of the lungs by measuring the air inhaled and the air exhaled

and how fast the air is exhaled.

 Allergy blood test: This is done to identify triggers. The allergens, allergy causing

substances could be pets, pollen, dust or chemical fumes. If allergy triggers are

identified, allergy shots may be recommended.

 Methacholine challenge test: Methacholine is known to trigger asthma. This test is

conducted when spirometry results are normal.

 Sputum eosinophils: The count of eosinophils, a type of white blood cells, found in

the sputum (mixture of mucus and saliva), helps in the diagnosis.

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MEDICAL MANAGEMENT

The aim of management is to relieve the immediate symptoms and reduce and control

inflammation, to prevent restructuring of the airways. Initial treatment should be adjusted

according to the level of control being achieved. Treatment is then stepped up and stepped

down to achieve and maintain control with minimum medication, thereby minimising the risk

of adverse effects.

Pharmacological management

Asthma medication is categorised into two groups: controllers and relievers.

Controllers are usually anti-inflammatory medications taken daily on a long-term basis to

maintain clinical control. Controllers include inhaled glucocorticosteroids taken alone or in

combination with long acting beta-2-agonists. Secondary agents, including anti-leukotrienes,

can be used in addition if necessary. Glucocorticosteroids work by reducing oedema and

airway spasm. Anti-leukotrienes work by blocking the action of leukotrienes, which attract

inflammatory-promoting eosinophils to the airway mucosa.

Relievers or rapidly acting beta-2-agonists are bronchodilator medications that stimulate beta-

adrenergic receptors to dilate the airways. Beta-2-agonists are taken on an as-needed basis to

reverse the bronchoconstriction and relieve the symptoms. Ideally, relievers should not be

required if the asthma is well controlled, and an increased use of reliever medication is a sign

of deteriorating control and increased inflammation.

Asthma treatment can be administered in inhaled, oral or injectable forms. A range of

different inhaler devices are available that allow greater choice in meeting patients’

preferences and maximising their adherence to treatment. However, all inhalers require

coordination, training and skill for effective use. Poor inhaler technique results in an

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inadequate delivery of medication to the airways and an increased deposition of medication

in the mouth, resulting in poor symptom control. Deposition of glucocorticoids in the mouth

can also lead to oral candidiasis

NURSING MANAGEMENT

The immediate nursing care of patients with asthma depends on the severity of symptoms.

The patient and family are often frightened and anxious because of the patient’s dyspnoea.

Therefore, a calm approach is an important aspect of care.

 Assess the patient’s respiratory status by monitoring the severity of symptoms, breath

sounds, peak flow, pulse oximetry, and vital signs.

 Obtain a history of allergic reactions to medications before administering

medications.

 Identify medications the patient is currently taking.

 Administer medications as prescribed and monitor the patient’s responses to those

medications; medications may include an antibiotic if the patient has an underlying

respiratory infection.

 Administer fluids if the patient is dehydrated.

 Assist with intubation procedure, if required.

Promoting Home- and Community-Based Care

 Teaching Patients Self-Care

 Teach patient and family about asthma (chronic inflammatory), purpose and action of

medications, triggers to avoid and how to do so, and proper inhalation technique.

 Instruct patient and family about peak-flow monitoring.

 Teach patient how to implement an action plan and how and when to seek assistance.

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  Obtain current educational materials for the patient based on the patient’s diagnosis,

causative factors, educational level, and cultural background.

 Continuing Care

 Emphasize adherence to prescribed therapy, preventive measures, and need for

follow-up appointments.

 Refer for home health nurse as indicated.

 Home visit to assess for allergens may be indicated (with recurrent exacerbations).

 Refer patient to community support groups.

 Remind patients and families about the importance of health promotion strategies and

recommended health screening

COMPLICATIONS

Uncontrolled long term asthma may lead to:

 Deterioration of lung function

 Increase in airway inflammation

 Interference in daily activities

 Weakness

 Hospitalization during severe attacks

PREVENTION

While there is no prevention for asthma, the symptoms and asthma attacks can be managed

through regular monitoring and treatment.

 Identify and avoid the triggers - triggers could be exercise, certain foods, pollen

 Follow medication as prescribed

 Learn proper use of inhalers - including cleaning the inhalers

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 Carry the inhalers and medicines to workplace/while travelling, to get an immediate

relief during the attack

 Monitor your breathing often. If you suspect breathing difficulty, wheezing or cough,

it is recommended to see the doctor

NUTRITION

Foods to eat:

 Foods rich in Vitamin C such as kiwis, broccoli, berries, oranges and tomatoes

 Foods rich in Vitamin E such as almonds, spinach and sweet potato

 Foods rich in omega-3 fatty acids such as canola oil, cod liver oil, flaxseed oil and

mustard oil

Food to avoid:

 Dried fruits like dried apricot

 Alcoholic drinks like wine or beer

 Frozen or prepared shrimp

 Food with high amount of sulphites and preservatives like pickles

 Food that is allergic to your body

REFERENCES

Health Condition (msn.com)

Medical%20Surgical%20Nursing/Handbook_Brunner_Suddarth's_Textbook.pdf

Medical-Surgical%20Nursing%20Demystified%20(%20PDFDrive%20).pdf

Fundamentals%20of%20Medical-Surgical%20Nursing%20-%20Brady,%20Anne-Marie.pdf

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